Ch. 12: Managing Patient with Extraglottic Device in Place

Question 1

Initial Assessment

Answer 1

• Is patient Ventilating? Use capnography
  
  • Mucous plug, position, balloon
• Is patient oxygenating?
  
  • If ventilating but not oxygenating it’s probably patient pathology.
  • Check for PTX
  • PEEP, inc oxygen, sedate or paralyze.
• Decompress the stomach
• Attach to ventilator.

Question 2

When to Exchange with an ETT

Answer 2

• If not ventilating exchange
• If going to the OR anesthesia can exchange
• If going to radiology or cath lab consider exchange
• Most EGDs can be left in for 4 hours or more.

Question 3

How to Exchange

Answer 3

• Decompress the stomach
• If retroglottic consider deflating proximal balloon and video laryngoscopy and bougie placement.
• Blind exchange through ILMA okay.
• Endoscopic exchange preferred.
  
  • Put the ETT into the EGD w ventilating sideport.
  • 2cc of air placed to keep in place
  • Use scope to locate trachea. Pass beyond.
  • Deflate ETT, pass it and reinflate
  • Remove scope then remove EGD
• If EGD is not big enough for ETT use exchange catheter
  
  • Some allow scope to pass within
• Once ETT in place you CAN leave the EGD in place until the light of day and resources available. Deflate the balloon.