Surgical Airways
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Transcript Surgical Airways
Amy Gutman MD
EMS Medical Director
[email protected] / www.teaems.com
Surgical airway indications
Airway anatomy review
QuickTrach© policy &
procedures
Utilizing a surgical airway
“assumes” provider followed the
Difficult Airway Pathway &
“Cannot Intubate, Cannot
Ventilate”
QuickTrach© is a rapid, safe &
reliable surgical airway device
Prehospital emergency
cricothyroidotomy rare
As with all rarely performed
skills, after initial training,
regular re-training required
Creation of an opening in
space between thyroid
cartilage anterior-inferior
border & cricoid cartilage
anterior-superior border to
access the subglottic airway
Allows endotracheal tube
placement when airway
control not possible by other
methods
Can’t Intubate, Can Ventilate
• 2 unsuccessful advanced airway
attempts (ETI, supraglottic)
• BVM maintains O2 sat >90%
Can’t Intubate, Can’t Ventilate
• 2 unsuccessful intubation
attempts (ETI, supraglottic)
• Cannot maintain O2 sat >90%
with BVM
ETI / NTI
Alternatives:
Biluminal
LMA
Combitube
Lighted Stylette
Unsuccessful
Successful
Cricothyrotomy
Or
Retrograde
Successful
Post Airway
Management
•
•
•
•
L
E
M
O
N
Look Externally
Evaluate 3-3-2
Mallampati
Obstruction
Neck Mobility
•
•
•
•
•
M
O
A
N
S
Mask Seal
Obese
Aged > 55yo
No Teeth
Snores / Stiff
Three Basic Steps:
• Insert, Inflate, Secure
Sterile sets pre-assembled for
immediate use
Needle tip reduces bleeding risk
Stopper prevents needle from being
inserted too deep reducing risk of
tracheal perforation
Neck-tape allows fast fixation
• Infants (1.5mm)
• Children (2mm)
• Adults (4mm)
• Uncuffed
• Larger Children
& Adults (4mm)
• Cuffed
1.5mm infant
• <3 yo
2mm pediatric
• <100 lbs
4mm size adult
• >100 lbs
Kits look similar except
for length
Massive trauma to larynx or
cricoid cartilage
Damage to affected structures
make it impossible to perform
procedure properly
Alternative or less invasive
maneuver allows ventilation
Hemorrhage
Esophageal perforation
Tracheal perforation
Tracheoesophageal fistula
Infection / Abcess
Subcutaneous air
Place patient supine with neck
slightly extended
• In-line stabilization if cervical
trauma suspected
Locate cricothyroid membrane
midline between thyroid
cartilage (Adam’s apple) &
cricoid cartilage
Prep overlying skin
Palpate thyroid & cricoid
cartilage for orientation
• A: Cricoid Cartilage
• B: Cricothyroid Membrane
• C: Incision Site
• D: Thyroid Cartilage
Puncture cricothyroid membrane at
90° angle
Confirm needle entry into trachea
by aspirating air
Change hand angle to 60°; slide
catheter sheath forward to stopper
hub level
Advance plastic cannula as you
remove needle & syringe
• If cuffed, then inflate with 2-3cc
Begin ventilation when needle &
syringe removed
http://www.youtube.com/watch?feature=player_de
tailpage&v=waHwm7QQ17M
Ventilate patient, observing for
chest rise & fall
Auscultate for BL breath sounds
• If absent, ETT may be in neck
subcutaneous fascia or esophagus
• Remove & attempt to re-insert
Secure device
Continuous evaluation &
documentation of oxygen
saturation, ETCO2, vitals
Notify ED of Priority 1 patient
Maine Department of EMS. “Advanced Airway
Training”. 2010
S Hopkins RN. “Equipment Review”. Condell Medical
Center EMS System. 2008
CPT A Proulx, MPAS, PA-C. “Airway Management in the
Combat Casualty”. 2011
Emergency Medicine: A Comprehensive Study Guide,
Tintinalli, 6th ed, Mcgraw-Hill, 2004
www.myrusch.com
Ron Walls Difficult Airway Management Text (2011)
Difficult Airway Site (www.theairwaysite.com)
Well-documented success in
prehospital, military & other
emergency settings
3 Basic Steps ~ Insert, Inflate,
Secure
Reduced time to advanced
airway placement in critical
patients who cannot be
ventilated
Rapid, safe & effective method
of providing a definitive
airway