Adv Airway Management Flashcards
why intubate (3 assesments)
- Is there a failure of airway maintenance or protection?
- Decreased LOC or unconscious patient loose muscle tone and airway reflexes
- Closed airway due to tongue obstruction
- obtunded to be at risk for serious aspiration
- Is there a failure of ventilation or oxygenation?
unable to ventilate adequately, or if adequate oxygenation cannot be
achieved despite the use of supplemental oxygen
Pt not breathing i.e. cardiac arrest, overdose
pt breathing, but not adequately, leading to hypoxia i.e. status asthmaticus
- What is the anticipated clinical course?
- Inhalation burns (aw swell)
- Status asthmaticus (WOB)
- Status epilepticus
- Head injuries
Why not test gag reflex
Inc ICP head injury pt
Cause aspiration in supine pt
- The absence of a gag reflex is neither sensitive nor specific as an indicator
of loss of airway protective reflexes. - The presence of a gag reflex has similarly not been demonstrated to ensure
the presence of airway protection.
Crash airway vs RSI
Crash airway:
Intubation w/out med
– AW reflexes
UC
+ agonal
Unresp to laryngoscopy
RSI
Meds to induce
Indications for SGA
- Maintain airway and ventilate a pt when ett not
indicated
*Theatre for elective surgery when patient has fasted - Backup airway device in EMS when you cant intubate
- Can use as primary airway when limited access to patient or lack of intubation
skills
Select SGA according to treatment plan
* Is it just for maintaining and ventilation?
* Do you need to decompress the stomach?
* Do you need to intubate the patient at a later stage?
Cook Classification of SGA
1st
* Simple breathing tube and mask to
form seal around larynx
* LMA & iGel
2nd
* Simple breathing tube and mask to
form seal around larynx
* Gastric drainage capability
* Proseal LMA
3rd
* Not well documented in literature
* Simple breathing tube and mask to
form seal around larynx
* Gastric drainage capability
* Provides mechanism for dynamic
sealing to prevent pressure necrosis
Miller classification of SGA
Miller classification
* Cuff sits around larynx to form a seal
(LMA)
* Cuff seals around pharynx (Cobra,
King LT & Combitube)
* No cuff but shaped to fit anatomy
(iGel)
Precaution of SGA
RODS
* Restrictive mouth opening
* Obstruction
* Disrupted or distorted airway
* Stiff lung or spinal injury
Placement of LMA
Placement of LMA
* Deflate cuff and lubricate the posterior part
* Open the airway by doing a head-tilt-chin-lift
* Use your finger to guide the mask, lift the jaw and insert it into the mouth
* Advance until it seats itself
* Inflate the cuff with the correct amount of air, as indicated
* Ventilate, assessing rise and fall of the chest
What is a difficult Airway
- When the practitioner experiences difficulty
with facemask ventilation, difficulty in
laryngoscopy, difficulty in tracheal intubation
or all three - Can be identified by a pre-intubation
assessments
Failed airway
When a provider has embarked on airway management and has
identified that intubation by that method is simply not going to
succeed, requiring the immediate initiation of a rescue sequence
* Failure to maintain acceptable oxygen saturations during or after one or more
failed laryngoscopic attempts or
* Three failed attempts at orotracheal intubation by an experienced operator
even when oxygen saturation can be maintained
Assesment of Mask O2
Moans
M: Mask seal (beard, trauma, bloods/vomit, size
O: Obesity or obstruction
A: Age (more than 55 years old)
N: No teeth
S: Stiff lungs (poor comp, eg copd, P ed
Intubation airway assesment
Lemon
L: Look externally
Small mandible, large tongue, large & protruding teeth, short neck,
obesity, burns, facial trauma, swelling of face or neck
E: Evaluate the 3-3-2 rule
gap of teeth
chin
hyoid
M: Mallampati
O: Obstruction
N: Neck mobility
8 ps of laryngoscopy
- Preparation
- Preoxygenation
- Plan for difficult / failed airway
- Positioning
- Protection
- Placement
- Proof of correct placement
- Post intubation management
How to prepare pt for tube
Prepare the patient
* Position
* 180° Access
* IV access
* Preoxygenation
How to prepare eq for tube
Prepare the equipment
* Intubation equipment
Baterries
Laryngescope
Syringe with air
cuff
- Vital signs monitoring
