Transcript Airway Management

Airway Management
GMVEMSC Education Committee
Objectives
Review proper airway management
 Review assessment
 Review adjuncts and proper use
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Airway Issues
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BLS intervention usually good
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Ensure patent airway
Practice good BVM airway management with Oral
or Nasal Airway Adjuncts
Advanced Airway Devices
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Intubation
Rescue Airways
Confirmation Methods (Use and Documentation)
Orotracheal Intubation
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Why
Securing patent airway
 Protects from aspiration
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Known Issues
Right mainstem intubation
 Unrecognized esophageal intubations
 Dislodged tubes
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Orotracheal Intubation
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Techniques
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Tools to assist
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Non Trauma
Inline Trauma
Fiberoptic scopes
Bougies
Viewmax blades
Grandview blades
Confirmation
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Probably done in most cases, lacks documentation
Nasotracheal Intubation
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Why
Spontaneously breathing patient
 Clenched jaw
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Known Issues
Use of too small an E.T. Tube
 Hypopharyngeal placement
 Trauma to airway
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Confirmation Methods
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“Dave’s Five”
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End Tidal CO2 OR EDD
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Detection
Waveform / Numerical Capnography
Visualization
Auscultation
Measurement at the teeth (or gum line in peds)
Chest Rise / Fall
Fogging of the tube
Skin color and change
Pulse Oximetry
Use Multiple Methods (at least five)
Confirmation Methods
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Other
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Apply Cervical Collar following intubation to
maintain head / neck position
Secure with commercial device or other methods
Document
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Include all methods used in your narrative
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Also document the results
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This should include at least five items
Especially capnography and / or colorimetric color change
Recheck of tube placement post movement
Rescue Airways
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When are they appropriate
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As a Primary Airway;
Due to suspected difficult airway capture based
on assessment and anatomical features
 Pediatric patients as preferred by Children’s
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As a Rescue Airway;
After failed attempts at intubation
 After failed attempt at intubation during the
Sedate to Intubate procedure.
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Types of Rescue Devices
LMA
 Combitube
 PTL
 King
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Laryngeal Mask Airway
http://www.lmana.com/unique.php
Laryngeal Mask Airway
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Why
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As an alternative to the face mask for achieving and
maintaining control of the airway.
LMA™ airways are indicated for use in:
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Known or unexpected difficult airways
Establishing an airway during resuscitation in the profoundly
unconscious patient with absent gag reflex
Known Issues
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Multiple sizes, based on weight, match correct syringe with
device to inflate cuff
Does not prevent aspiration
Improper placement (cuff folded over)
EDD is not recommended as a confirmation device with the
LMA
Is NOT a medication route for Endotracheal drugs
Combitube
http://www.combitube.org/
Combitube
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Why
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Unconscious / unresponsive patients without gag reflex
Blind insertion technique
Alternative to E.T.T.
Known Issues
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Two sizes, limited to patients over 4 foot.
Obtaining proper seal / placement
Ventilating through correct tube
Is NOT a medication route for Endotracheal drugs unless placed in
the trachea (i.e. ventilating tube 2) (consult mfg recommendations)
Contraindications
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Patients with intact gag reflexes
Patient's height below 4 feet
Patients with known esophageal pathology
Patients after ingestion of caustic substances
Central-airway obstruction
PTL
Gettig Pharmaceutical Instrument Company
http://216.92.52.175/ptl.html
PTL
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Why
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Unconscious / unresponsive patients without gag reflex
Blind insertion technique
Alternative to E.T.T.
Known Issues
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Obtaining proper seal / placement
Ventilating through correct tube
Is NOT a medication route for Endotracheal drugs unless it is placed
in the trachea (consult manufacturer recommendations)
CONTRAINDICATIONS:
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Children - under the age of 14
Conscious or semiconscious patients
Known caustic poisoning cases
Known esophageal disease
King Airway
http://www.kingsystems.com/
King Airway
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Why
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Unconscious / unresponsive patients without gag reflex
Blind insertion technique
Alternative to E.T.T.
Known Issues
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Obtaining proper seal / placement
Is NOT a medication route for Endotracheal drugs
Multiple sizes, based on height, also multiple cuff volumes
Contraindications
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Responsive patients with an intact gag reflex.
Patients with known esophageal disease.
Patients who have ingested caustic substances.
Conclusion
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Many devices available to providers
Be familiar with what you have available to
your organization.
Immobilize to maintain head / neck position.
Recheck lung sounds and End Tidal CO2
frequently
Document device use and at least five
confirmation methods used with results.
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Questions / Discussion