M : MINIMAL DRUGS
The moral of this section is: “CHOOSE YOUR DRUGS WISELY”.
Which drug you use to put your obese patient into a state in which they’ll tolerate intubation relates to experience/familiarity, institutional factors, and side-effect profile of the drug. In general the goal is to achieve a state where the risk of hypoxia is minimized, and the chance of placing the tube 1st time are maximized. Also, simplicity rules in these situations: the less things you need to get out, draw up and inject, the less room there is for error.
Risk factors for poor outcomes from anaphylaxis include delayed treatment with epinephrine and a history of asthma , particularly uncontrolled asthma. The vast majority of deaths from anaphylaxis occur from in-hospital administration of medications. In the community, the most common causes of poor outcomes are stinging-insect allergy in adults and a history of peanut and tree nut allergy . Death from anaphylaxis from these causes is usually associated with delayed treatment with epinephrine. If recognized and treated promptly with epinephrine, the prognosis for anaphylaxis is generally good and the vast majority of patients experience a full recovery.
Although patients with ARDS initially may be managed while breathing spontaneously with supplemental oxygen, hypoxemia is progressive and many patients require intubation and mechanical ventilation. Initial settings commonly used are the assist-control mode with provision of adequate positive end-expiratory pressure (PEEP). The use of high F io 2 concentration has been associated with pathologic changes in the lung such as edema, alveolar thickening, and fibrinous exudate. 19 To avoid this toxicity, the F io 2 should be titrated toward as long as oxygen saturation can be maintained at 90 percent or higher.