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Basic Airway Management

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  • Basic Airway Management

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

    Airway stabilization

  • Head Tilt/Chin Lift

  • Jaw Thrust

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

  • Oropharyngeal Airway

    PresenterPresentation Notessupport heavy base of tonguelip to angle mandible

  • Nasopharyngeal Airway

    PresenterPresentation Notesoxygenate past floppy soft palatenares to angle mandible

  • Bag-Valve Mask

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

  • 1 Person BVM

    PresenterPresentation NotesC-Eseal

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

    2 person BVM

    PresenterPresentation NotesAnn Emerg Med. 2014 Jan;63(1):6-12.e3J Emerg Med. 2013 May;44(5):1028-33Ann Emerg Med. 2014 Jan;63(1):14-5J Clin Anesth. 2013 May;25(3):193-7

  • Positioning

  • Pediatric Positioning

    PresenterPresentation Notesear 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

    PresenterPresentation Notesif stridor audible =90% obstruction!

  • 3-3-2

    PresenterPresentation Notesif 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)

    PresenterPresentation Notesetomidate 0.3fentanyl 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)

    PresenterPresentation NotesHyperkalemiarhabdo, DKA, hyperK, burns > 48 hours, crush injuryHead trauma, increased intraocular pressure, glaucomaNeuromuscular: 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

    PresenterPresentation Notesoptimize 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

  • PresenterPresentation Notes3x 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 ManagementSlide Number 2Slide Number 3Slide Number 4Head Tilt/Chin LiftJaw ThrustOropharyngeal AirwayNasopharyngeal AirwayBag-Valve Mask1 Person BVMSlide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16PositioningPediatric PositioningSlide Number 19Airway AssessmentDifficult to Intubate (LEMON)3-3-2Mallampatti ScoreDifficult to Intubate (LEMON)Slide Number 25RSI: InductionRSI: ParalysisSlide Number 28Intubation TechniquePlacing tubeSlide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Post intubationSlide Number 38