Sunday, September 13, 2015

Q: You were called to evaluate a patient. On arrival at bedside you find a fairly obese patient in impending respiratory failure. As you start preparing and to perform intubation, you asked Respiratory Therapist to apply "cricoid pressure". As soon as he is in process of applying cricoid pressure, patient had a huge forceful vomiting. You quickly  get the bed's head down, turned patient's head to the side, and suctioned the mouth.  Your next step? (Next best)

A) Continue to apply cricoid pressure
B) Let go of cricoid pressure
C) Abandon the whole procedure
D) Start rapid mask bag ventilation
E) Insert Orogastric tube, clean the stomach and then proceed with intubation

Answer: B

In case should patient shows active forceful vomiting, further cricoid pressure should be avoided as it may cause esophageal rupture. 

Choice 'C' is wrong as patient may 'code' and die. Instead preferably patient should be quickly  intubated taking all safe precautions with inflation of the endotracheal tube cuff as quickly as possible.

Choice 'D' is not a good choice as further bag mask ventilation may further inflate the stomach. If oxygenation is sufficient to pass the intubation phase, it should be avoided.

Choice 'E' may be applied if you have luxury of time, which is unfortunately not the case in such situation.

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