Intubating patient with metabolic acidosis

Q: Patients with severe metabolic acidosis may not be able to tolerate Rapid Sequence Intubation (RSI). What is the exact etiology behind it?

Answer:  Patients with severe Metabolic acidosis can deteriorate within seconds, even with a very short apnea episode during RSI. Apnea abruptly halts the compensatory elimination of carbon dioxide, leading to hemodynamic collapse, hard to salvage.

Related podcast:  Intubating the patient with Severe Metabolic Acidosis

Link: https://emcrit.org/?powerpress_pinw=37-podcast   (Scott Weingart M.D)


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References: 

 1. Scott Weingart. Podcast 3 – Laryngoscope as a Murder Weapon (LAMW) Series – Ventilatory Kills – Intubating the patient with Severe Metabolic Acidosis. EMCrit Blog. Published on May 22, 2009. Accessed on January 3rd 2020. 

2. Available at [https://emcrit.org/emcrit/tube-severe-acidosis/. Grant S et al. Ventilator-Assisted Preoxygenation: Protocol for Combining Non-Invasive Ventilation and Apnoeic Oxygenation Using a Portable Ventilator. EMA 2016; 28: 67 – 72. PMID: 26764895