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Fiberoptic is great for tube placement, there should be fiberoptic training and practice for all who are responsible for securing an airway. Fiberoptic intubation by a practitioner with experience can provide a diagnostic information as well. Given the injuries, I would have been looking for subglottic bleeding, and the integrity of the airway to the carina and below, as well as ET placement.. IMHO, fiberoptic intubation can be faster that Cricothyrotomy. Fiberoptic intubation is less traumatic, and " muddys" the water less that cricothyrotomy. We already have enough neck trauma to deal with!

The choice of Etomidate was a good one. This agent does support hemodynamic stability, in the face of hypotension, better than Diprivan or Sodium Pentothal. Ketamine would be a choice, and probably my chioce, because it lasts longer and has better sympathomimetic ability. Ketamine also provides analgesia which the hypnotics do not. I would have opted for Ketamine as an induction/sedation agent!

Sux( Anectine ) is also a great relaxant because of its' speed of onset and short duration. Sux needs to be followed up with a Nondepolarizer after a few minutes. Something not many know is that a metabolite of Succinlycholine ( Sux/ Anectine ) is succinnylmonocholine, which, in its self, is a non-depolarizing relaxant. It is known as a phase II block, and is time and dose related. A phase II block is usually seen after multiple injections, or "dip infusion" after bolus administration for intubation, usually seen during C-section under general anesthesia. Phase II block is resistant to reversal, and just requires a " tincture of time " to resolve. I suspect that if Anectine were presented to the FDA today for patient use, it would not make it!

Great case Dutch!!

SS,, sometimes it is hard to resist putting the NIBP cuff around the neck! I have always been a proponent fo replacing cells with cells in cases like this.

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