Advanced airway support Flashcards
Components of rapid clinical airway assessment
Level of responsiveness Skin colour Resp rate Depth of respirations (O2 sats +/- capnography if pt not in impending resp arrest)
Components of basic airway management in conscious patient
Position in seated position
If laying, optimise position to open the airway (sniffing position, or chin left/jaw thrust)
Drain secretions
INITIAL approach to conscious patients unable to adequately open their airway - options?
And precautions with which adjuncts?
Optimal positioning
Nasal trumpets 1 or 2 (if not anti-coagulated or no risk for mid-face fractures)
Oral airway (gudel) may be used if no gag reflex
Supplemental O2 to sats >94%
When to consider NIPPV?
If ventilation / respiratory effort is adequate but oxygenation or clearance of CO2 is poor
As a temporising measure while other treatments are initiated (e.g. nitrates in acute cardiogenic pulmonary oedema)
For pre-oxygenation prior to intubation
As an alternative to invasive airway support in patients with DNR or treatment limitations
Initial approach to patients with poor respiratory effort
Bag mask ventilation
- place pt in sniffing position with airway adjuncts (oral gudel, nasal trumpets)
How to pre-oxygenate before intubation
Using non-rebreather mask at max oxygen flow rates, NIPPV
or bag mask ventillaiton if patient is not ventilating adequately (in which case place nasal cannula with 15L/min O2 flow under the mask)
At what level of O2 prior to attempted intubation is the patient at risk of critical desaturation after apnoea is induced?
Less than or equal to 93%
Options for IV induction agent and doses
Basic resuscitation-based reasons to avoid certain agents?
Etomidate: 0.3mg/kg (excellent choice most circumstances)
Ketamine 1-2mg/kg (some cases of hypotension and hypertension reported)
Propofol 0.5-1.5mg/kg (if not at risk of hypotension)
When to give the paralytic agent?
Immediately flush the induction agent with the paralytic agent
Options for paralytic agents, and doses (and basic reasons to avoid each)
Succinylcholine 1-2mg/kg total body weight (unless risk of serious hyperkalaemia - e.g. renal failure, neuromuscular disorders, subacute spinal cord injury, crush injury, burns)
Rocuranium 1-1.5mg/kg IDEAL BW
Reasons to avoid succinylcholine as a paralytic agent in intubation?
(include dose)
1-2mg/kg total BW
Avoid if risk of serious hyperkalaemia - e.g. renal failure, neuromuscular disorders, subacute spinal cord injury, crush injury, burns
How long do succinylcholine and rocuranium take to take effect?
Succinylcholine: 30-45 seconds
Rocuranium: 60 seconds
(continue pre-oxygenation during this period)
Basic approach to insert blades (basic curved type)
Insert at R side of mouth and sweep tongue to the left
Both blades are advanced into the valeculla to trigger the hyoepiglottic ligament
Withdraw blades slowly till epiglottis drops into view
Then lift with tip of blade along the axis of the handle to open view of vocal cords, without chipping teeth
