Advanced airways Flashcards
Types of Adjunct Airways
● Oropharyngeal
○ Obtunded or no gag reflex
○ Corner of the mouth to angle mandible
● Nasopharyngeal
○ May tolerate if gag reflex intact
○ Contraindicated if midface trauma
○ Tip of the nose to the earlobe
● Requires lubrication
NIPPV
● Gives the entering air a bit of a “shove”
● Face or nasal mask
● Cooperative, alert, with intact ventilation effort
● Used as pre-intubation if a patient is struggling
CPAP vs BiPAP
CPAP
● Constant positive pressure
through resp cycle
BiPAP
● Different pressures with
inhalation and exhalation
Noninvasive Positive Pressure Ventilation
● Mask seal
● Uncomfortable
● Air trapping
● Pulmonary barotrauma
● ↑intrathoracic pressure
○ ↓ cardiac output
Supraglottic Airway
● Placed in oropharynx
○ Tracheal insertion not required
○ Placed blindly
● Essentially an internal mask
● Unconscious, cardiac arrest, or difficult mask
ventilation
● Not used if prolonged, bridge to endotracheal
intubation
Supraglottic vs ET tube
● ET better seal, lower risk aspiration
● SGA higher risk mucosal damage
● ET is better when use is prolonged
● SGA can be used to rescue a failed
intubation
Tracheal Intubation
● Endotracheal tube (ET tube) is
placed past through vocal cords
● Definitive airway patency
● Prevents aspiration
● Sedation and paralysis for
critically ill
Causes for Airway Difficulty
● Obesity
● Neck flexibility or concurrent
C-spine management
● Airway obstruction eg. Epiglottitis
○ Mallampati criteria
○ Convert to a surgical airway
● Bougie could be used
Steps to Confirm placement of tube
● Via visualization during insertion- best
● Chest auscultation, symmetric chest wall expansion
● Capnography
● Ultrasound and/or chest X-ray
Rapid Sequence Intubation relative contraindications
● Difficult airway
● When blocking agent may not help with vocal cord exposure
● Always be prepared for failure of intubation
Induction Agents for rapid sequence intubations
● Deep sedation limited duration
Etomidate- not analgesic
Propofol- hypotension a concern
Ketamine- analgesia and amnesia
Paralytic Agents for rapid sequence intubations
● Not anxiolytic or analgesicsedation is required
Succinylcholine- Hyperkalemia
● Concern post burn, denervation,
crush, renal failure (preexisitng Kᐩ)
Rocuronium- shorter duration
Emergency Cricothyrotomy: when necessary and unncecessary?
● Severe facial trauma
● Failed intubation
● Contraindicated in children
< 10 years old
○ Use over the needle
catheter via cricothyrotomy
