EMCrit Podcast 206 – ApOx, ENDAO, & PreOx Update - a podcast by Scott D. Weingart, MD FCCM

We've spoken a ton on EMCrit on Apneic Oxygenation and Preoxygenation, well here is some more. Nick Caputo and his Lincoln Airway Group did an amazing trial of ApOx in the ED. Rory recently wrote about it and there have been some amazing posts around the FOAM world as well (see Rory's post). Now I weigh in with my take and a discussion of my new thoughts on PreOx.

Three Items to Read



* The ENDAO Trial

* Sakles' Editorial

* The EMNerd Post



Also See



* Fellow Trial Post

* EMCrit Preox



Should we use Nasal Cannula?

I think yes, because:



* ApOx will still probably benefit some patients (probably those without sig. physiological shunt or those whom you have recruited)

* Makes BVM mask leaks better

* Allows apneic CPAP with the devices below



Why Doesn't It Work in this RCT?



* Great Preox

* Not Enough Potential for Sig. Desat due to rapidity and ease of intubation

* THRIVE NC is Different than Standard

* Physiologic Shunt-Shunt Fraction would be a great thing to know to interpret these studies



What Should be on the Patient's Face just prior to Induction

choose one:



* Vent as Bag with BVM Mask

* Oxylator with BVM Mask

* BiPAP Machine with BVM Mask

* Ultimate BVM with PEEP Valve, Pressure Gauge



All of the above should have a NC @ >15 lpm and ETCO2 capnography



Why not the Mapleson C (or similar)? I'd like a pressure gauge on that badboy to track each breath

Update

Ivan Pavlov updated the tables from our MA (Am J Emerg Med. 2017 Aug;35(8):1184-1189) to include the Caputo trial:



Clinically Sig. Hypoxemia



SpO2<80%



Death

Additional Articles of Interest



* Narrative review of ApOx in Anesthesia realm (PMID 28050802)



Update

Peter Young Sent me this interesting poster on THRIVE and Pressure

Now on to the Podcast...

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