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- Feed Preview Comments on: EMCrit 40 – Delayed Sequence Intubation (DSI)
By: Scott Weingart, MD FCCM
In reply to jlinderj5507. if I translate the ? correctly; it is not a ? of DSI. The ? is does keeping a patient on nasal CPAP increase i...
By: jlinderj5507
A singular advantage to DSI would seem to be the patient keeps breathing thereby lowering the intubaters stress level and improving his chances for success. Also, since the patient is still breat...
By: Ali Eskandar
Thank you scott for your lecture I learned alot !!! I need to ask you did you have the chance to publish your case series ? I would like to bring DSI topic to ecommunity chest network for further...
By: Scott Weingart, MD FCCM
In reply to Scott Gallagher. not in adults, which is the only area I have ever advocated DSI. Adults have never had a case of periproced...
By: Scott Gallagher
Scott, I love the DSI concept. However, because there is very little negative discussion of the concept I would like to share that I had a case recently in a child. I administered Ketamine to a 2...
By: Scott Weingart, MD FCCM
In reply to Mike. Great stuff, Mike
By: Mike
Hi Scott - thanks for all your work with the website very useful stuff. Recently I used DSI to successfully intubate a non resolving post-ictal patient (sidenote - I am a critical care flight Par...
By: Leon
In reply to Scott Weingart, MD FCCM. Scott/Minh or anyone else, You ever had a really hypoxic, precarious patient such as the one describ...
By: Scott Weingart, MD FCCM
In reply to MichaelMD. great stuff!
By: MichaelMD
I had a patient the other night come in with flash pulmonary edema, but also febrile from a nursing home. Wasn't sure if it was his CHF or ARDS, but he looked awful. Despite CPAP of 5 by prehospi...
By: Scott Weingart, MD FCCM
In reply to Josh Farkas. Those are exactly the pts that avoid intubation. Dexmedetomidine works nicely for DSI as well. The advantage of ...
By: Josh Farkas
Scott, Brilliant podcast, thanks. I am especially interested in the subset of patients who get ketamine or precedex and then improve and don't require intubation. There seem to be a subset of pat...
By: Scott Weingart, MD FCCM
In reply to Javier Benitez. I discuss this extensively here: https://emcrit.org/emcrit/dsi/#comment-8454
By: Javier Benitez
Happy 4th I'm going through the literature of DSI now. My patient is agitated, acidotic, tachypneic, and hypoxic is DSI ideal for this patient? Thanks in advance Javier
By: Doug
In reply to Scott Weingart, MD FCCM. Thanks. I used Midazolam IM, got patient transferred to bed, NRB mask, IV access, RSI with Propofol/...
By: Scott Weingart, MD FCCM
In reply to Doug. Minh's blog, PHARM is the best source for info on that exact que...
By: Doug
Scott: Can you comment on the use of Ketamine and DSI in the Excited Delirium patient (specifically PCP, Cocaine, Bath Salt toxicity). Handcuffed, profusely diaphoretic, tachycardic, highly agita...
By: Seth Trueger
In reply to Scott Gallagher. my concern about RSA is that you are paralyzing a patient who is not optimally preoxygenated -- the margin f...
By: Scott Weingart, MD FCCM
In reply to Chris Cresswell. my experience, and i think the literature bears this out, is that haldol is slower and less sedating. you mi...
By: Chris Cresswell
Great work as always Scott - waiting for the next blue, agitated patient to come in. For those of us without easy access to droperidol - is there much difference between droperidol and haloperido...
By: paul
looking forward to giving this a whirl on my next appropriate patient. am limited by not having dex at my shop (or droperidol. hahaha)
By: Scott Weingart, MD FCCM
In reply to David Marr. Ketamine is a potent analgesic, no additional pain control should be necessary. If you are using demedetomidine, ...
By: Scott Weingart, MD FCCM
In reply to Scott Gallagher. Darren Braude's RSA technique is another great way to go and I have used it a bunch. Great dexmedetomidine r...
By: Scott Weingart, MD FCCM
In reply to PH. Folks, this could be made to work with many sedative agents, but I can't recommend any of them, b/c the potential to scre...
By: Scott Weingart, MD FCCM
In reply to Matt L. Wong. fixed thanks to Matt
By: David Marr
What about pain management with the DSi sequence. At what point would you give your first dose of Fentanyl, and would you use the same dose as with a true RSI like 3mcg/kg?
By: Nico
In reply to Sebastian. I'd suggest you read this piece... Myth: Ketamine should not be used as an induction agent for intubation in patie...
By: Scott Gallagher
I like your approach with Ketamine. I think that it is conceptually similar to the rapid sequence airway (RSA) approach advocated on the UNM airway site as a bridge to intubation(http://hsc.unm.e...
By: PH
In reply to Erin Schneider. a small dosage of propofol would do nicely
By: Erin Schneider
What do you suggest for the hypertensive tachycardic patient if you do not have dex available?
By: Matt L. Wong
Great ideas and a great article. I love your work. However, check the URL in the JEM article you provide for the video demonstration. Should it still be "blog.emcrit.org/misc/preox" or simply "em...
By: Sebastian
Nice article !! I only suggest to include a note saying that ketamine should be avoided in agitation do to TBI or stroke, because it enhance oxygen consumption in the brain and increase damage. G...