Basic Airway Management - haecc.orghaecc.org/wp-content/uploads/2017/10/CKS-basic-airway-for-St.-Luke… · Basic Airway Management • Open the airway – Chin lift – Jaw thrust

Basic Airway Management

• Open the airway– Chin lift– Jaw thrust– Oropharyngeal airway– Nasopharyngeal airway

Airway stabilization

Head Tilt/Chin Lift

Jaw Thrust

Oropharyngeal Airway

Nasopharyngeal Airway

Bag-Valve Mask

• Important to master!• 1 person vs 2 person BVM

1 Person BVM

• 2 thumbs up• 4 fingers jaw• Jaw thrust• Adjuncts

2 person BVM

Positioning

Pediatric Positioning

Airway Assessment

• Reason for intubation • AMPLE history• Exam: LEMON• 3-3-1

Difficult to Intubate (LEMON)

• Look at head and neck• Evaluate 3-3-1• Mallampati score• Obstruction: hot potato voice, secretions,

stridor• Neck mobility

3-3-2

Mallampatti Score

Difficult to Intubate (LEMON)

• Look at head and neck• Evaluate 3-3-1• Mallampati Score• Obstruction: hot potato voice, secretions,

stridor• Neck mobility

RSI: Induction• Ketamine (2 mg/kg)

– Good for hemodynamically unstable

– Good for obstructive airway

– Safe in intracranial hypertension

• Midazolam (0.3mg/kg)

• Propofol (2 mg/kg)

– HTN, sympathomimetic

– Disappears quickly (i.e. before paralytic does)

RSI: Paralysis

• Succinylcholine 1.5 mg/kg– Shorter time onset (30second), duration (10

minutes)– Contraindications

• Hyperkalemia, Burns, Neuromuscular

• Vecuronium 0.2 mg/kg – Longer time onset (60s) and duration (30min)

Intubation Technique

Placing tube• Optimize Patient Positioning

• Scissor Mouth, assistant pulls right corner

• Insert laryngoscope right

• Sweep tongue left

• Visualize epiglottis “up and out” not rock

• External laryngeal manipulation “bimanual intubation”

• Keep your eye on the prize

• Place and confirm placement

Post intubation

• Confirmation:– Visualize passing cords– Fog in tube– Bilat breathsounds, no gastric– CO2 detector– Chest X-ray

• Tie or tape tube • Sedation!