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

Presenter

Presentation Notes

when not want to chin lift/head tilt? c-spine

Oropharyngeal Airway

Presenter

Presentation Notes

support heavy base of tongue lip to angle mandible

Nasopharyngeal Airway

Presenter

Presentation Notes

oxygenate past floppy soft palate nares to angle mandible

Bag-Valve Mask

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

1 Person BVM

Presenter

Presentation Notes

C-E seal

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

2 person BVM

Presenter

Presentation Notes

Ann Emerg Med. 2014 Jan;63(1):6-12.e3 J Emerg Med. 2013 May;44(5):1028-33 Ann Emerg Med. 2014 Jan;63(1):14-5 J Clin Anesth. 2013 May;25(3):193-7

Positioning

Pediatric Positioning

Presenter

Presentation Notes

ear to sternal notch

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

Presenter

Presentation Notes

if stridor audible =90% obstruction!

3-3-2

Presenter

Presentation Notes

if stridor audible =90% obstruction!

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)

Presenter

Presentation Notes

etomidate 0.3 fentanyl 2-10 mcg/kg

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)

Presenter

Presentation Notes

Hyperkalemia rhabdo, DKA, hyperK, burns > 48 hours, crush injury Head trauma, increased intraocular pressure, glaucoma Neuromuscular: MS, ALS, muscular dystrophies, stroke/spinal cord, tetanus, botulism

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

Presenter

Presentation Notes

optimize the head: put your right hand under the patient’s head and do sniff and head tilt seat the blade: either in the vallecula, or on the epiglottis itself, then gently lift optimize the larynx: use your right hand to maneuver the thyroid cartilage into optimal position that’s the best view you’re going to get on this attempt. if it’s not good enough, ventilate before your next attempt change something for the love of god, use a bougie, advance the ETT or bougie from the right side and twist, do not lever

Presenter

Presentation Notes

3x size

Post intubation

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

• Tie or tape tube • Sedation!

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

Documents