Advanced Airway Principles Flashcards
Intubation Indications
Unable to swallow
cannot ventilate/oxygenate (failed airway algorithm)
GCS <8
Expected clinical course (inhal. burns, circum. burns, anaphylaxis)
Apnea
Airway obstruction
Respiratory Failure
In respiratory failure, only one value needs to be off to indicate the need to intubate. These values include:
pH, CO2, PaO2
LEMON pneumonic
Look Evaluate 3-3-2 Mallampati (I-IV) Obstructions Neck Mobility
3-3-2 rule
3 fingers in mouth
3 fingers btw jaw and hyoid
2 fingers between hyoid and thyroid
Airway Grading
Mallampati
Mallampati I
soft palate
uvula
anterior/posterior tonsillar pillars visible
Patients with a tall, thin neck are usually graded Mallampati
I
Difficulty level of Mallampati I
none
Mallampati II
Tonsillar pillars hidden by tongue
Difficulty level of Mallampati II
none
Mallampati III
Only base of uvula seen
Difficulty level of Mallampati III
Moderate
Mallampati IV
Uvula cannot be seen
Short, fat or muscular neck
Difficulty level of Mallampati IV
Severe
Curved blade that lifts vallecula
Macintosh
Straight blade that lifts the epiglottis
Miller
Direct downward pressure on the thyroid cartilage occluding esophagus and preventing aspiration during intubation:
Sellick’s Maneuver
Do NOT release Sellick’s Maneuver or BURP until intubation is
complete
BURP pneumonic
Backward
Upward
Rightward
Pressure
FAILED AIRWAY ALGORITHM
Patient requires secured airway
3 attempts of direct laryngoscopy unsucc.
Ventilate by BVM/simple airway/blind airway
Unable to ventilate/oxygenate SaO2 >90%
Cricothyroidotomy indicated (Cric)
Gold standard of placement confirmation
Chest X-ray
Distal tip of ETT should be
2-3 cm above carina or
1” above carina or
level of T2 or T3 vertebrae
2nd most reliable confirmation method
visualization of tube passing thru cords
When inflating the distal cuff on an ETT, the pressure should be between
20-30 mmHg to prevent mucosal tissue damage (only use amt required to make good seal)
