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Transcript of “Life Threatening Airway Obstruction” - foocus.com · “Life Threatening Airway Obstruction”...

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Life Threatening Airway Obstruction

Bob Kacmarek PhD, RRTHarvard Medical School

Massachusetts General HospitalBoston, Massachusetts

9-28-17 FOCUS

Conflict of Interest DisclosureRobert M Kacmarek

I disclose the following financial relationships with commercial entities that produce healthcare-related products or services relevant to the content I am presenting:

Company Relationship Content AreaCovidien Consultant Mech VentCovidien Grant Mech VentOrange Med Consultant Mech VentVenner Medical Grant Artificial Airways

Benumof, Airway Management: Principles and Practice Mosby 1996 Benumof, Airway Management: Principles and Practice Mosby 1996

ASA Practice Guildelines; Management of the Difficult Airway

Anesthesiology 2003;98:1269

Mallampati ClassificationGurinder J Anesth 2008:22;38

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Cormack and Lehane Laryngoscopy Grade Gurinder J Anesth 2008:22;38 Rocke Anes

1992;77:67 Mallampati

Score PI

protruding Incisors

SN Short neck

RM receding mandible

ASA Practice Guildelines;

Management of the Difficult

Airway Anesthesiology 2003;98:1269

ASA Practice Guildelines; Management of the Difficult Airway Anesthesiology 2003;98:1269

ASA Practice Guildelines; Management of the Difficult Airway

Anesthesiology 2003;98:1269

ASA Practice Guildelines; Management of the Difficult Airway Anesthesiology 2003;98:1269

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Benumof, Airway Management: Principles and Practice Mosby 1996 Benumof, Airway Management: Principles and Practice Mosby 1996

Benumof, Airway Management: Principles and Practice Mosby 1996 Benumof, Airway Management: Principles and Practice Mosby 1996

Benumof, Airway

Management: Principles and Practice Mosby 1996

Laryngeal Mask Airway LMR, Intubating LMR

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King Laryngeal Tube

Benumof, Airway Management: Principles and

Practice Mosby 1996

ROGERS Anes

1983;59:569

Ovassapian Fiberoptic Airway Endoscopy in Anes and CC Raven Press 1990

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Peterson Anes 2005;103:33

Patterns of liabilioty associated with malpractice claims arising from management of the difficult Airway ASA closed claims database, 179 cases between 1985 and 1999 Evaluated period before and after the original ASA difficult airway guidelines published in 1993 Compared 2 period 1985-1991 and 1993-1999

Peterson Anes

2005;103:33

Peterson Anes

2005;103:33

Peterson Anes 2005;103:33

Peterson Anes

2005;103:33

Peterson Anes

2005;103:33

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Kheterpal Anes 2009;110:891

Observational study over a 4 year period Each adult undergoing general anesthesia Preoperative patient characteristics, detailed airway physical exam and airway outcome were recorded Primary outcome impossible mask ventilation despite multiple providers, airway adjuncts or neuromuscular blockade

Kheterpal Anes 2009;110:891

Kheterpal Anes 2009;110:891 Kheterpal Anes 2009;110:891

Kheterpal Anes 2009;110:891Liu, Kacmarek Brit J Anes 2013;110;456

Percutaneous transtracheal ventilation (PTV) via a jet ventilator is considered rescue in difficult airway managementAdult lung simulation1 inch long 14 gauge IV catheter placed into the midpoint of a 150 ml dead space tracheaCatheter directed toward the lung, the month and perpendicular PEEP values used to simulation airway obstructionVentilated by jet and conventional ventilator.

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Liu, Kacmarek Brit J Anes 2013;110;456 Liu, Kacmarek Brit J Anes 2013;110;456

Liu, Kacmarek Brit J Anes 2013;110;456

Liu, Kacmarek Brit J Anes 2013;110;456

Liu, Kacmarek Brit J Anes 2013;110;456 ASA Practice Guildelines; Management of the Difficult Airway

Anesthesiology 2003;98:1269

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ASA Practice Guildelines;

Management of the Difficult

Airway Anesthesiology 2003;98:1269

Thank You