Own the Oxygen!

By now everyone should have read this paper:

Weingart SD, Levitan RM. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Ann Emerg Med. 2012 Mar;59(3):165-75.e1. Epub 2011 Nov 3. Review. PubMed PMID: 22050948.

It is the only paper to have been included in two separate editions of R&R in the FASTLANE (because it is SO DAMN IMPORTANT) and it was the inaugural R&R Hall of Famer. If you haven’t read it, you really have no excuse because the article is available for free on the Annals EM Site (pdf) (no idea why that link has a line through it – it works!).

I gave a talk on this paper soon after it was epublished last year. Here is the slide show, it’s an easy question and answer format so that you can get the main messages with a minimum of fuss:

I was thinking of uploading a ‘voiced over’ version, again because the paper is SO DAMN IMPORTANT, but now I don’t have too.

Why? You ask.

Because our buddy over at ERCAST, Rob Orman, isn’t satisfied with ‘owning the anus‘ and has decided to ‘own the oxygen‘ too… And he sounds way cooler than me:

Update 18 May 2012:

Seth Trueger (@MDaware) talks about the work he has been doing with Scott Weingart on the Delayed Sequence Intubation (DSI) approach to oxygenation of the critically patient.

For more resources on oxygenation for emergency intubation check out:

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  1. Thomas Plappert says

    Great post, great article for one of the most important topics in em. thanx a lot!
    for a satt. < 90% despite high-flow-oxygen, i "bag up" after rsi with an laryngeal-tube (King-LT) before starting the intubation, esp. in high-risk-patients and/or in pre-hospital settings.


    • says

      Thanks Thomas
      Sounds like you use a ‘rapid sequence airway’ (RSA) approach -- probably similar to Darren Braude’s technique:

      Ideally those patients should get non-invasive ventilation as part of pre-ox even before any drugs are administered. Weingart’s ‘delayed sequence intubation’ approach is valuable here.

  2. says

    Thank you so much for this. I was just looking at some of this data for an ACLS guide that I’m contributing to. A previous edition focused tremendously on hyperventilation and my gut reaction was to much of it out. This information really helped me clarify Best Practices approach for the text.