Advanced Airway Management Flashcards
Difference between DSI and RSI
DSI: requires procedural sedation for pre oxygenation. For pts that have an altered mental status, ETOH, drugs, mental illness. Ketamine preferred 1-1.5mg/kg, pre oxygenate, administer paralytic then intubate
RSI: near simultaneous administration of anaesthetic and paralytic. Purpose of RSI is intended to minimise risk of aspiration
9 steps.
ETT placement of proof
Visualisation of cords, capnography, auscultation, condensation, chest rise and fall, chest xray
Risk factors for a difficult airway
Short neck, large tongue and teeth, burns
Airway obstruction (blood,vomit, trauma)
The need for speed - pt deteriorating
Uncooperative pt
Morbidly obese
C-spine immobilisation
Impaired oxygenation
Fibro optic intubation
Often performed in pts with c-spine injury or instability.
Can be performed when pt is awake
Can be used diagnostically during and or after FIO to facilitate inspection of airway
Used in difficult airways
Bougie
Once the bougie is in the trachea, keeping the laryngoscope in place enhances the chance of successful intubation.
Pre-shaping the bougie facilitates successful intubation.
Blind bougie is associated with trauma
Surgical airway set up
Scalpel blade size 10
Artery forceps
Bougie
Size 6 ETT and 10ml syringe
BMV - with ETCO2 detector pre attached
Confirm placement with ETCO2, auscultation, bilateral rise and fall, fogging of tube
Indications and nursing considerations for CICO
When attempts to manage the airway by tracheal intubation, BMV, and supraglottic have failed. Unable to intubate, unable to oxygenate.
Know where the equipment is and set up
Bougie, 6.0 ETT lubricated
How will the pt be oxygenated post insertion? BMV? Connect tubing to O2
Co2 monitoring
100% O2 should be applied to the upper airway through out
Neck extension is required
Needle cricothyroidotomy
Ventilation can only be achieved using a high pressure source and is associated with risk of barotrauma
Retrograde intubation
Two parts: guidance consists of retrograde insertion of catheter from the larynx to the mouth or nose and the blind part is the insertion of a ETT into the trachea without visualisations of the cords
Pre oxygenation
Head/back elevated approx 20-25degrees
Oxygenation with face mask reservoir, non- rebreather, BVM and adjunct nasal cannula set at 15L/min for 3 mins or until Sats are above 93%
In patients with intact respiratory drive 3 minutes of tidal volume breathing with a tightly sealed FiO2 source is sufficient
In cases where O2 Sats >93% can not be achieved with BMV/NRB, NIV should be initiated
RSI checklist
Pre oxygenation
Position- ear to sternal notch
RAMP if obese
Paralysis and sedation for all
Crisped pressure for all initially but release if poor view
Bougie for all
Planning a failed airway in RSA in adults
Plan A - facemask ventilation and ETT with laryngoscope max 2 attempts
Plan B- maintain O2 Sats, SAD insertion
Plan C- face mask ventilation - wake patient up
Plan D- CICO
Managing a difficult airway vortex approach
Best effort at oral intubation failed
BVM - focus on re-oxygenating the pt
When SpO2 > 95% team to prepear for next attempt
To optimise BMV - manipulation of head and neck- sniffing position, jaw thrust, manipulation of larynx, manipulation of device (2 handed technique)
Adjuncts: OPA, NPA, bougie, blades
Suction
Pharyngeal muscle tone
Complications of a needle crico
Pneumothorax
Subcutaneous and mediastinal emphysema
Bleeding
Respiratory acidosis will worsen due to hypoventilation
Landmarks for a crico
Find the thyroid cartilage and the thyroid cartilage
The area between these is a membrane in cricothyroid space
