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Are You Driving in the HOV Lane?

Resuscitate before you intubate!

Part of the Protected Airway Series

Your in the driver’s seat, cruising down the fast lane towards your next intubation in the Emergency Department. But before you take your next patient along for the ride, you should ask yourself if your driving in the HOV lane.

It’s important to remember that we don’t intubate healthy people for elective procedures in the Emergency Department. When a definitive airway is needed we intervene because the physiology of our sick patient is requiring us to act to protect them from further harm.

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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 sick patients.

Fortunately, a little knowledge and planning can help you navigate this intersection between dangerous physiology and endotracheal intubation by understanding how they combine to cause harm. One way to do this is to ask yourself, “is my patient in the HOV lane?”

The HOV mnemonic — Hypotension, Oxygenation, Ventilation (pH) is a simple way to organize some of the key concepts and clinical skills required for protecting your sick patients during the dangerous peri-intubation period. Here it is:

The full presentation with notes is available on HAIKUDECK.

The EMBER  – Curated FOAM content all bundled in one place

For deeper cuts on this topic there is no better source than Dr Scott Weingart’s “Laryngoscope as a Murder Weapon” series.  The most comprehensive, innovative and valuable series of lectures on this topic I know of.


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

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