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Views and opinions expressed do not necessarily reflect those of GS-ACEP, The Department of Defense, the U.S. Government, the North American Continent, the Western Hemisphere, or Mother Earth.
Objectives
Anatomy/PhysiologyAirway AssessmentAirway ManagementEquipment and MedicationsSkills Practice
Airway assessment
Look, listen, feel (noisy is bad) Rate/Quality
Breathing fast? Working hard? Shallow breaths? Chest rising?
Airway assessment: Monitor
Pulse oximetry The “oxygenation” vital sign >94%
Capnography (End Tidal CO2) The “ventilation” vital sign 35-45mmHg
Airway assessment
Predicting a difficult intubation Limited neck mobility Large tongue Facial trauma Malampati score
Airway management
Position Ear-to-sternal notch
Universal ventilation and intubation position
Independent of age and size
Airway management
Unconscious/no gag reflex intubateConfused/combative patients are hypoxic until proven otherwise
Airway management
Cricoid pressure (Sellick maneuver) no longer recommended Aspiration still can occur Makes it difficult to ventilate…complete
AW occlusion in 11% Detrimental effects on view and blocks
tube passage MRI studies show esophageal occlusion
not reliable
Airway management
However, external manipulation of the thyroid cartilage by the person intubating is helpful to improve view
Equipment and medications
SOAP ‘EM Suction Oxygen (BVM ready and pre-
oxygenate) Airway adjuncts (OPA, NPA) Position End Tidal CO2 (Capnography or
colormetric device) Meds & Monitors
Equipment
SuctionOxygen Delivery Nasal cannula, simple mask, non-rebreather
Must be at least 10L/min
5-12L/min
Equipment
Airway Adjuncts Oropharyngeal airway
Only in a comatose patient (will gag) Measure corner of mouth to ear lobe
Equipment: Advanced airway
Endotracheal tube (ETT) and laryngoscope
Laryngoscope Handle
Tape to secure tube
Laryngoscope Blade (here is a Miller)
Syringe to inflate the cuff ETT and
Stylet
Equipment: advanced airway
3. Bougie into opening
4. Slide 6-0 ETT over bougie, remove bougie and secure tube
Cricothyroidotomy
Equipment: medications
1st = Sedate Etomidate Ketamine Midazolam (or other benzodiazepine)
2nd = Paralyze Succinylcholine Rocuronium Vecuronium
Skills practice…Go!
Intubation set up O2, BVM, suction, pulse ox,
laryngoscope, tube(s), stylet, syringe, CO2
Medications Paralytics Sedatives
Rescue devicesCricothyroidotomy