Anatomy Review and S.A.L.T.™ Overviewwww.learninginterest.com

Objectives Name the major components of the upper

and lower airways Describe the functions of the upper and

lower airways Describe the process of ventilation Describe the process of respiration Identify the S.A.L.T.™ device Demonstrate use of the S.A.L.T.™ device Explain the SMO for the S.A.L.T.™ device

Upper and Lower Airways

Upper Airway Anatomy

Upper Airway System

Lower Airway Anatomy

Ventilation & Respiration

Alveolar Function

Supraglottic Airway Laryngopharangeal Tube

“The S.A.L.T.™ is a unique single patient use oropharyngeal airway which can be utilized to facilitate blind, endotracheal intubation. The S.A.L.T.™ can also be utilized to reduce accidental endotracheal tube extubation.”

Using the S.A.L.T.™ Device

Standing Medical Order*A. Open Airway

1. Manual maneuvers2. Clear obstructions using the appropriate

techniques/suction3. If necessary, insert appropriate airway

device to maintain the airway (i.e. oropharyngeal, nasopharyngeal, endotracheal tube, S.A.L.T. ™, Combi-tube/King Airway, cricothyrotomy)

*The following SMO is provided as an example only. Check with your Medical Director for the current Airway Management SMO at your service.

Standing Medical Order4. Intubate any unconscious patient without a gag reflex

a. monitor patient’s pulse oximetry and cardiac rhythm at all times to prevent unrecognized hypoxia

b. hyper oxygenate prior to intubation attemptc. if not able to place tube within 30 sec., withdraw, hyper

oxygenate, and re-attemptd. verify placement using Ambu tube check device,

observing appropriate chest rise, end tidal CO2

monitoring, and auscultation of breath soundse. orotracheal or nasotracheal intubation as indicatedf. secure tube with ET tube holder (pediatric – use tape)g. in the cardiac arrest situation, initial airway

management should be completed with manual maneuvers, & simple adjuncts.

Standing Medical Order5. After two unsuccessful attempts at intubation by

direct laryngoscopy, hyper oxygenate the patient, place S.A.L.T. ™ adjunct, hyper oxygenate, then intubate through the S.A.L.T. ™. The S.A.L.T. ™ is only indicated in patients for whom 6.5mm through 9.0mm ETT is appropriate.

6. Nasotracheal intubation and nasal airways should be avoided in the patient with facial trauma, or suspected basal skull fracture.

7. Extreme caution should be exercised in any patient experiencing significant head injury, or with signs of rising intracranial pressure.

Standing Medical Order8. With suspected head injuries, administer

Lidocaine 1.5 mg/kg prior to ETT intubation to help prevent rise in ICP.

9. For any patient with a GCS < 8, complete endotracheal intubation

10. Only if necessary, in the unusually difficult intubation, and when the patient can not otherwise be oxygenated by basic life support measures, consider giving Versed (or valium) 5 mg IVP + Morphine Sulfate 2 mg IVP to facilitate intubation per Medication Facilitated Intubation Standing Order.

Standing Medical Order11. A Combi-tube/King Airway should be used if

attempts at intubation with the S.A.L.T. ™ are unsuccessful. For EMT-I’s, the Combi-tube/King Airway is the advanced airway for utilization. The Combi-tube/King Airway is contraindicated in the following:

a. patients under 5 feet in height or over 6’4” in height

b. patients who are less than 16 years of agec. patients who weigh less than 90 lbsd. patients who have known esophageal diseasee. patients who have ingested caustic substances

Objectives Review Name the major components of the upper

and lower airways Describe the functions of the upper and

lower airways Describe the process of ventilation Describe the process of respiration Identify the S.A.L.T.™ device Demonstrate use of the S.A.L.T.™ device Explain the SMO for the S.A.L.T.™ device

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