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If patient has borderline or low sats and AMS, what strategy is best for pre-oxygenation?
Delayed Sequence Intubation
If NIPPV not an option for pre-oxygenation, what's another good option?
Use a nasal cannula set above 15 and a BVM with a PEEP valve
below what pressure can you safely bag a patient without insuflating the stomach?
25 mmHg, so you can bag them, but do it gently; even use the vent, if you have to
Patient is at risk for dysrhythmia, hypoxemic brain injury, hemodynamic instability at sats lower than...
70%
At sats below 70%, what are the risks to the patient?
dysrhythmia
hypoxemic brain injury
hemodynamic instability
When does patient hit the drop-off point in the hemoglobin dissociation curve?
~88-90%, so important to keep them above this during the peri-intubation phase
What % O2 do the standard NRB's provide?
~60-70% FiO2
How can you augment the standard NRB?
Turn O2 up past 15L
Add NC
How long should patients breath on high flow O2 for pre-oxygenation?
3 minutes,

And this can be reduce if you...
Have the patient take 8 vital capacity breaths (then 1 minute suffices)
Why might a patient on high flow FiO2 NRB not achieve adequate sats and what should you do?
Shunt physiology - perfused, but not oxygenated alveoli.

Examples: PNA, aspiration, CHF, ARDS, hemorrhage
Use NIPPV or BVM w/ PEEP valve and NC
In what position should patients be pre-oxygenated?
HOB 20 degrees.

What if they have spinal injuiry contra-indicating this?
Reverse Trendelenberg (feet down, head up)
Approach to low risk patients
1. Position
2. Pre-oxygenate
3. No PEEP necessary
Approach to high risk patients (sats 91-95% on NRB)
1. Position
2. Pre-oxygenate w/ PEEP
3. Apneic oxygenation