LARYNGOSPASM
You’re doing a procedural sedation in pediatrics. Despite your attending’s forewarning, you push that IV ketamine a bit too quickly. Suddenly, you hear a loud “crowing” or “squeaking” sound and look up at the monitor to see a flat line on capnography. Your heart sinks as it dawns upon you that you caused the much-dreaded laryngospasm.
WHAT DO I DO?!
1. Stop all procedures
2. Perform Larson’s maneuver - this is a modified jaw thrust maneuver where pressure is applied towards the top of the ramus of the mandible
3. Use a bag valve mask with PEEP valve and 100% oxygen to provide continuous positive airway pressure
4. Ask your team to prepare for intubation
5. Deepen anesthesia with IV propofol (0.5mg/kg IV push)
Most cases of laryngospasm will resolve with these maneuvers and propofol. In the rare event it doesn’t…
6. Give an IV paralytic (rocuronium 1mg/kg IV or succinylcholine 1.5mg/kg IV) and proceed to intubate.
Sources: Justin Morgenstern, "Managing laryngospasm in the emergency department", First10EM blog, March 3, 2016. Available at: https://first10em.com/laryngospasm/.
Alejandro Romero
EM PGY-3