Airway Management
OBJECTIVES Review airway anatomy Discuss blind insertion / extraglottic airway
adjuncts Identify techniques for endotracheal intubation Identify techniques for cricothyroidotomy
Basic Airway Management Positioning Airway adjuncts
Nasopharyngeal airway Oropharyngeal airway
Suction
Oxygen administrationOxygen L/min Approximate Fio2%
Nasal cannula
1 24
2 28
3 32
4 36
5 40
6 44
Simple Face Mask 40-60
Non-rebreathing Mask 12-15 80-100
Extra-glottic Devices Laryngeal Mask Airway (LMA) King LT I-gel
Blind Insertion Airway Device (BIAD) Indications
Inadequate respiratory drive
Respiratory failure other than:
Burns, anaphylaxis, or other causes of airway swelling/obstruction
Contraindications Massive airway
trauma distorting anatomy
Penetrating neck trauma
WARNING: BIADs may not prevent or block aspiration of gastric contents
BIAD Procedure Prepare, position, and preoxygenate Select appropriate size BIAD and ensure proper cuff inflation/deflation Lubricate with water-soluble jelly Advance tube towards posterior pharynx until seated in correct position Inflate balloon per package insert and attemp BVM If good airflow/chest rise
Secure device in place and ventilate with BVM/vent
If unable to ventilate / resistance Deflate balloon, pass second BIAD
Consider paralytic/analgesia/sedation when placing supraglotic airway devices.Be prepared for vomiting / aspiration!!
Laryngeal Mask Airway (LMA)
Intubating LMA (Fastrach)
LMA Insertion Video
LMA Insertion
King LT
King LT Insertion Video
Endotracheal Intubation Indications
Diminished level of consciousness with loss of airway control Absent or diminished gag reflex GCS < 8 Potential for aspiration (secretions, blood, vomitus)
Respiratory failure Cardiac arrest
Endotracheal Intubation
Direct Laryngoscopy Equipment
PPE ET tubes of various sizes ET tube stylet Laryngoscope handle and blade Suction 10 mL syringe Tube holding device ETCO2 device Rescue airway
Bougie Assisted Intubation
DL View
Endotracheal Intubation Video
Rapid Sequence Induction Pretreatment
Head injury: fentanyl 3 mcg/kg IV
Induction Etomidate 0.3mg/kg (24 mg in 80 kg adult) Ketamine 1-2 mg/kg (80-160 mg in 80 kg adult) Midazolam 0.1 mg/kg (8 mg in 80 kg adult)
Paralytic Vecuronium 0.1 mg/kg (8 mg in 80 kg adult) Rocuronium 1 mg/kg (80 mg in 80 kg adult) Succinylcholine 1.5 mg/kg (120 mg in 80 kg adult)
Continued Sedation Ketamine (PREFERRED FOR BATTLEFIELD TRAUMA)
0.5-1 mg/kg q 10-20 minutes 1-2 mg/kg/hr continuous infusion
Propofol (NO PAIN CONTROL) 0.5-1.5 mg/kg q 5-10 minutes 10-50 mcg/kg/min continuous infusion
Midazolam ( NO PAIN CONTROL) 0.1 mg/kg q 15-30 minutes
Fentanyl 0.5-2 mcg/kg q 30-60 minutes
Bougie Assisted Tactile Intubation
Face-to-Face Intubation Hold the laryngoscope in the right hand with
blade facing forward like a hatchet Hold ET tube in left hand Insert blade into right side of patient’s mouth,
sweep the tongue to the patient’s left, and visualize the cords
Cricothyrotomy
Videos Scalpel, finger, bougie Realworld cric Cric practice
Nu-Trake Cric Kit
Needle Cric
Airway Management
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