Intubation in the Critically Ill Patient

Part of the Protected Airway Series
Are you driving in the HOV lane?

We don’t intubate healthy people for elective procedures in Emergency Medicine. When a definitive airway is needed, it’s because the patient’s situation is currently (or soon will be) incompatible with life. We intervene because the physiology of our sick patient is requiring us to act.

But the intersection of critically ill physiology and endotracheal intubation is a dangerous one: we can quickly turn a problem into a disaster if we focus only on the mechanics of the procedure, and fail to prepare for the effects this will have on our patients.

Fortunately, you can prepare for that intersection between dangerous physiology and endotracheal intubation by understanding how they combine to cause harm. Simply ask yourself, “is my patient in the HOV lane?” and you will be better prepared to navigate smoothly through this dangerous intersection.

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The HOV mnemonic — Hypotension, Oxygenation, Ventilation (pH) is one I developed recently for an upcoming critical care teaching session with our residents, and will also be incorporated into the Protected Airway Series. It’s a simple way to organize some of the key concepts and clinical skills required for protecting your sick patients from harm during this dangerous peri-intubation period . The full presentation is available here on HAIKUDECK.

Is Your Patient in the HOV Lane- Avoid disaster after intubating the critically ill patient.013Where did the HOV mnemonic come from? The use of mnemonics (LEMON, MOANS, SOAP-ME and the list goes on) in airway education is not new. This one is simply my way to make the material stick in my brain when I need it.

It came to me as a surprise mashup (only click on this link if you have five minutes for a completely entertaining diversion) one afternoon while browsing posts by that wonderful Aussie Matt Cadogan  on Life In the Fast Lane, not long after watching an EMCrit Video on the HOP Killers by the prodigious Scott Weingart. Something about the two stuck, and the HOV mnemonic was born. So thanks to both for the inspiration.

The EMBER  cropped-the-ember-haiku-header-001.jpg– Curated FOAM content all bundled in one place

EMCrit – Laryngoscope as a Murder Weapon (LAMW) Series – By Scott Weingart.

Life In the Fast Lane – Own the Airway! – by 


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