Session 5: Ancillary Airway Flashcards
Difficult airway algorigthm
utilized to drive actions during difficult airway scenarios
if initial intubation attempts unsuccessful
consider:
calling for help
returning to spontaneous ventilation
awakening pt
if face mask ventilation is adequate,
nonemergency
try alternative options to intubat
glidescope
videoscope
cmac
if facemask ventilation no adequate, consider
using a LMA
if LMA not adequate/feasible,
this is an emergency
call for help
emergency noninvasive airway ventilation
emergency invasive airway access
video larygoscopy view
indirect
video laryngoscopy indications
limited mouth opening
inability to flex neck
dont want to flex neck (cervical surgery)
video laryngoscopy limitations
upper secretion (Plegm)
blood
vomit
false sense of security
glidescope
specific brand of videoscope
fixed angle
disposible outer clear blade
glidescope line of sight
none required
CMAC
different brand of glidescope
comes in disposable and reusable variety
CMAC reusable uses
thinner profile
easier to use for limited mouth opening
very ueseful with certain conditions
McGrath
handheld
battery operated
smaller screen
portable
disposable cover/blade
Other types of scopes
Bullard
WuScope
Upsherscope
irrelevant with advent of video-laryngoscopy
Airtraq
utilizes mirrors to see anterior larynx
disposable
80% effective after failed DL
battery operated
Truview
regular laryngoscope handle attachment
optical port
light source
oxygenating port
exagerated angle distal tip
Differences between video and DL
insertion can be challenging w/cord/handle
little elevation with handle necessary
(less next extension/manipulation)
video laryngoscopy complications
potential for oral trauma
potential for great visualization w/o ability to intubate
Fastrach LMA
intubate through the LMA
Bougie Catheter
solid exchanger
15Fr (5mm)
cuff replacements
initial intubation guide
Bougie Process - Initial Intubation
- normal DL
- intubate trachea w/bougie
- remove blade/hold bougie
- place ETT over bougie
- slide ETT into trachea
- if resistance, slight twist/forward pressure
- remove bougie
- inflate cuff
- test ventilate
Bougie Process - Tube Exchange
- disconnect circuit
- advance bougie past end of ETT
- 3cm beyond tube depth at teeth
- deflate cuff/remove ETT
- advance new ETT over bougie
- remove bougie
- inflate cuff
- test ventilate
ETT size
larger size = larger length
Frova Catheter
cannulated Bougie
(has hole in end)
15mm airway adapter
allows for vent connection/passive oxygenation
Sizes: 8, 14 Fr
Cook Catheter
larger than Frova
allows for more oxygen flow
Sizes: 8, 11, 14, 19 Fr
Aintree Tube Exchanger/Catheter
allows for bronchoscope insertion through exchanger
oxygenating capable
6.5mm OD
use ETT 7+
Arndt Airway exchanger/catheter
retrograde intubation
tapered tip to help facilitate with seldinder wire assistance
LTA
apply local anesthetic on cords, carina, trachea
lidocaine 4% topical solution
Adult dose: 160mg or 4mL
remove protective reflex of epiglottis
- no food/drink 1 hr post-LTA
