Airway Management

OBJECTIVES Review airway anatomy Discuss blind insertion / extraglottic airway

adjuncts Identify techniques for endotracheal intubation Identify techniques for cricothyroidotomy

Basic Airway Management Positioning Airway adjuncts

Nasopharyngeal airway Oropharyngeal airway

Suction

Oxygen administrationOxygen L/min Approximate Fio2%

Nasal cannula

1 24

2 28

3 32

4 36

5 40

6 44

Simple Face Mask 40-60

Non-rebreathing Mask 12-15 80-100

Extra-glottic Devices Laryngeal Mask Airway (LMA) King LT I-gel

Blind Insertion Airway Device (BIAD) Indications

Inadequate respiratory drive

Respiratory failure other than:

Burns, anaphylaxis, or other causes of airway swelling/obstruction

Contraindications Massive airway

trauma distorting anatomy

Penetrating neck trauma

WARNING: BIADs may not prevent or block aspiration of gastric contents

BIAD Procedure Prepare, position, and preoxygenate Select appropriate size BIAD and ensure proper cuff inflation/deflation Lubricate with water-soluble jelly Advance tube towards posterior pharynx until seated in correct position Inflate balloon per package insert and attemp BVM If good airflow/chest rise

Secure device in place and ventilate with BVM/vent

If unable to ventilate / resistance Deflate balloon, pass second BIAD

Consider paralytic/analgesia/sedation when placing supraglotic airway devices.Be prepared for vomiting / aspiration!!

Laryngeal Mask Airway (LMA)

Intubating LMA (Fastrach)

LMA Insertion Video

LMA Insertion

King LT

King LT Insertion Video

Endotracheal Intubation Indications

Diminished level of consciousness with loss of airway control Absent or diminished gag reflex GCS < 8 Potential for aspiration (secretions, blood, vomitus)

Respiratory failure Cardiac arrest

Endotracheal Intubation

Direct Laryngoscopy Equipment

PPE ET tubes of various sizes ET tube stylet Laryngoscope handle and blade Suction 10 mL syringe Tube holding device ETCO2 device Rescue airway

Bougie Assisted Intubation

DL View

Endotracheal Intubation Video

Rapid Sequence Induction Pretreatment

Head injury: fentanyl 3 mcg/kg IV

Induction Etomidate 0.3mg/kg (24 mg in 80 kg adult) Ketamine 1-2 mg/kg (80-160 mg in 80 kg adult) Midazolam 0.1 mg/kg (8 mg in 80 kg adult)

Paralytic Vecuronium 0.1 mg/kg (8 mg in 80 kg adult) Rocuronium 1 mg/kg (80 mg in 80 kg adult) Succinylcholine 1.5 mg/kg (120 mg in 80 kg adult)

Continued Sedation Ketamine (PREFERRED FOR BATTLEFIELD TRAUMA)

0.5-1 mg/kg q 10-20 minutes 1-2 mg/kg/hr continuous infusion

Propofol (NO PAIN CONTROL) 0.5-1.5 mg/kg q 5-10 minutes 10-50 mcg/kg/min continuous infusion

Midazolam ( NO PAIN CONTROL) 0.1 mg/kg q 15-30 minutes

Fentanyl 0.5-2 mcg/kg q 30-60 minutes

Bougie Assisted Tactile Intubation

Face-to-Face Intubation Hold the laryngoscope in the right hand with

blade facing forward like a hatchet Hold ET tube in left hand Insert blade into right side of patient’s mouth,

sweep the tongue to the patient’s left, and visualize the cords

Cricothyrotomy

Videos Scalpel, finger, bougie Realworld cric Cric practice

Nu-Trake Cric Kit

Needle Cric

Airway Management