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Airway Management

Airway Management. GMVEMSC Education Committee. Objectives. Review proper airway management Review assessment Review adjuncts and proper use. Airway Issues. BLS intervention usually good Ensure patent airway Practice good BVM airway management with Oral or Nasal Airway Adjuncts

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Airway Management

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  1. Airway Management GMVEMSC Education Committee

  2. Objectives • Review proper airway management • Review assessment • Review adjuncts and proper use

  3. Airway Issues • BLS intervention usually good • Ensure patent airway • Practice good BVM airway management with Oral or Nasal Airway Adjuncts • Advanced Airway Devices • Intubation • Rescue Airways • Confirmation Methods (Use and Documentation)

  4. Orotracheal Intubation • Why • Securing patent airway • Protects from aspiration • Known Issues • Right mainstem intubation • Unrecognized esophageal intubations • Dislodged tubes

  5. Orotracheal Intubation • Techniques • Non Trauma • Inline Trauma • Tools to assist • Fiberoptic scopes • Bougies • Viewmax blades • Grandview blades • Confirmation • Probably done in most cases, lacks documentation

  6. Nasotracheal Intubation • Why • Spontaneously breathing patient • Clenched jaw • Known Issues • Use of too small an E.T. Tube • Hypopharyngeal placement • Trauma to airway

  7. Confirmation Methods • “Dave’s Five” • End Tidal CO2 OR EDD • Detection • Waveform / Numerical Capnography • Visualization • Auscultation • Measurement at the teeth (or gum line in peds) • Chest Rise / Fall • Fogging of the tube • Skin color and change • Pulse Oximetry • Use Multiple Methods (at least five)

  8. Confirmation Methods • Other • Apply Cervical Collar following intubation to maintain head / neck position • Secure with commercial device or other methods • Document • Include all methods used in your narrative • This should include at least five items • Also document the results • Especially capnography and / or colorimetric color change • Recheck of tube placement post movement

  9. Rescue Airways • When are they appropriate • As a Primary Airway; • Due to suspected difficult airway capture based on assessment and anatomical features • Pediatric patients as preferred by Children’s • As a Rescue Airway; • After failed attempts at intubation • After failed attempt at intubation during the Sedate to Intubate procedure.

  10. Types of Rescue Devices • LMA • Combitube • PTL • King

  11. Laryngeal Mask Airway http://www.lmana.com/unique.php

  12. Laryngeal Mask Airway • Why • As an alternative to the face mask for achieving and maintaining control of the airway. • LMA™ airways are indicated for use in: • Known or unexpected difficult airways • Establishing an airway during resuscitation in the profoundly unconscious patient with absent gag reflex • Known Issues • Multiple sizes, based on weight, match correct syringe with device to inflate cuff • Does not prevent aspiration • Improper placement (cuff folded over) • EDD is not recommended as a confirmation device with the LMA • Is NOT a medication route for Endotracheal drugs

  13. Combitube http://www.combitube.org/

  14. Combitube • Why • Unconscious / unresponsive patients without gag reflex • Blind insertion technique • Alternative to E.T.T. • Known Issues • Two sizes, limited to patients over 4 foot. • Obtaining proper seal / placement • Ventilating through correct tube • Is NOT a medication route for Endotracheal drugs unless placed in the trachea (i.e. ventilating tube 2) (consult mfg recommendations) • Contraindications • Patients with intact gag reflexes • Patient's height below 4 feet • Patients with known esophageal pathology • Patients after ingestion of caustic substances • Central-airway obstruction

  15. PTL Gettig Pharmaceutical Instrument Company http://216.92.52.175/ptl.html

  16. PTL • Why • Unconscious / unresponsive patients without gag reflex • Blind insertion technique • Alternative to E.T.T. • Known Issues • Obtaining proper seal / placement • Ventilating through correct tube • Is NOT a medication route for Endotracheal drugs unless it is placed in the trachea (consult manufacturer recommendations) • CONTRAINDICATIONS: • Children - under the age of 14 • Conscious or semiconscious patients • Known caustic poisoning cases • Known esophageal disease

  17. King Airway http://www.kingsystems.com/

  18. King Airway • Why • Unconscious / unresponsive patients without gag reflex • Blind insertion technique • Alternative to E.T.T. • Known Issues • Obtaining proper seal / placement • Is NOT a medication route for Endotracheal drugs • Multiple sizes, based on height, also multiple cuff volumes • Contraindications • Responsive patients with an intact gag reflex. • Patients with known esophageal disease. • Patients who have ingested caustic substances.

  19. Conclusion • Many devices available to providers • Be familiar with what you have available to your organization. • Immobilize to maintain head / neck position. • Recheck lung sounds and End Tidal CO2 frequently • Document device use and at least five confirmation methods used with results.

  20. Questions / Discussion

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