Advanced airway decisions Paul Satterlee MD FACEP Allina Health EMS
Advanced airway decisions
Paul Satterlee MD FACEP
Allina Health EMS
Conflicts of Interest
• I have no financial conflicts related to the content of this discussion
Objectives
• Review typical difficult airway management suggestions
• Apply these interventions to cases
• Discuss new ideas on advanced airway management
Decision Making
To intubate or not
Predict the difficult airway
• LEMON
• Look• Large incisors
• 3-3-2
• Mallampati
• Obstruction
• Neck mobility
What about this?
Your Skill is the Decision
• To intubate
• More consistent positive pressure and peep for increased oxygenation
• Control of rate and tidal volume to optimize ventilation
• Fluid control (Vomit)
• Not to intubate
• Head injury victims may do worse
• VAP rates are 8-28%, with a 25-50% mortality
• Hyperventilation
Simple aids
• Backwards, upwards and rightward procedure
• Bimanual manipulation
Positioning
• Towel roll?
• Ears to sternal notch
• Dr. Rich Levitan
Obstruction
• Suction works great for blood, but what about pizza?
• MacGills
Needle Cric
Case
How goes that physical exam?
Case 2
Best Case