In this episode of Tox in Ten, host Elissa Moore (@ElissaMoore3) explores the evidence and recommendations surrounding intubation of the salicylate toxic patient.
The Cliff’s Notes Version:
This month’s podcast asks what do we do for patients with severe toxicity who are no longer protecting their airway or have severe respiratory fatigue?
- Avoid intubation if at all possible.
- When the decision is made to intubate take the time to prepare and limit the period of apnea/hypoventilation.
- Bolus with several amps of bicarbonate prior to sedation.
- Use appropriate ventilator settings to maximize your patient’s minute ventilation. Try to match their respiratory rate prior to intubation.
- Closely monitor blood gasses and clinical status, making frequent adjustments as needed.
- Consider early initiation of hemodialysis.
Greenberg, Michael I., Robert G. Hendrickson, and Maryann Hofman. “Deleterious effects of endotracheal intubation in salicylate poisoning.” Annals of emergency medicine 41.4 (2003): 583-584.
McCabe, Daniel J., and Jenny J. Lu. “The association of hemodialysis and survival in intubated salicylate-poisoned patients.” The American journal of emergency medicine 35.6 (2017): 899-903.
Stolbach, Andrew I., Robert S. Hoffman, and Lewis S. Nelson. “Mechanical Ventilation Was Associated with Acidemia in a Case Series of Salicylate‐poisoned Patients.” Academic Emergency Medicine 15.9 (2008): 866-869.