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Airway Management Part II

Airway Management Part II. Adjuncts & Devices. Zachary Wm. Drathman. Equipment. Know what you need Find an area to work in Check your cuff Lube the tube Shape your tube appropriately Educate your EMTs Capnography. Laerdal’s “The Bag” BVM. Utilize the “C” & “E” grip

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Airway Management Part II

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  1. Airway ManagementPart II Adjuncts & Devices Zachary Wm. Drathman

  2. Equipment • Know what you need • Find an area to work in • Check your cuff • Lube the tube • Shape your tube appropriately • Educate your EMTs • Capnography

  3. Laerdal’s “The Bag” BVM

  4. Utilize the “C” & “E” grip for a good seal Save the Kung Fu grip for kicking ass!

  5. “C” & “E” grip One handed!

  6. Respect Your BVM Getting sleepy Top five reasons to love the BVM • Delivers 100% O2 • Every Engine has one • Your very own CPAP • 1600ml of 02 at your finger tips • EMT + BVM = adjustable ventilator

  7. Make Your BVM Work For You! • Perfect for those CHFers: Improve gas exchange Decrease V Q mismatch Decrease Work of Breathing (WOB) • No “Plastic Cigar” for those HODs Maintain O2 saturation while providing better living through Pharmacology.

  8. BVM: One size fits all? • Static BVM volume: 1600ml • Normal human inhalation: 500ml • Max inhalation: 3500ml • Max exhalation: 1200ml • Stuck inside:2300ml • COPD (Asthma/Empysema) Prolonged Expiratory Phase Mmmm Cigarettes!

  9. Understanding Air Trapping Bronchospasm leads to an inability to efficiently exhale Increasing ventilatory rate compounds the problem.

  10. Air Trapping in the COPDer Healthy lungs: Supple, Elastic Emphysema Lungs: Distended, Inflexible

  11. You know what they say about big hands? • Firemen like to do things all or nothing. • Define what you are looking for: Volume, Rate, Flow • Listen for O2 flowing (or not) • Monitor rate & volume being delivered • Check on status routinely • Spread the word of Sellick

  12. Sellick and Burping • “Cric Pressure” should be in every EMTs toolkit… But it’s not. • Very helpful for HODs requiring BVM. “I love the smell of vomit in the morning!” • Teach firemen how toBURP! • Backward • Up • Rightward • Pressure

  13. So you got the tube. Now what?

  14. Colormetric Meter (CO2 Detector)

  15. Colormetric CO2 Detection Devise • Inflate cuff • Remove syringe • Affix ETCO2 detector • Observe color change • Purple > Yellow

  16. Ascultate For Final Confirmation Shut up! They’re students. They won’t even notice. Use quick shallow ventilations Listen at epigastrum first Listen at both lung fields Dude! You forgot the syringe.

  17. Capnographic Device {Medtronic Microstream EtCO2 Circuit}

  18. Capnography New devise for old concept. Old devise: Colormetric New devise: Graphical / Quantitative Uses: Tube confirmation (initial / ongoing) CPR effectiveness Numbers: 35 to 40 is great Any number >10 means a good tube

  19. Secure & Re-Confirm • Try for “22 at the teeth” but let lung sounds be your guide • Apply Thomas tube holder Always confirm tube placement: • After securing • After loading • Before unloading • After unloading

  20. Thomas Endotracheal Tube Holder Route neck strap prior to intbubation. Secure neck strap THEN clamp tube.

  21. Laryngeal Mask Airway (LMA) Rescue devise NOT tube replacement!

  22. Monitoring • Periodic respiratory rate check • Lifepak monitoring • With audible QRS • Know the character of your patient’s ventilatory phase • SPO2 monitor on • EtCo2 monitor on

  23. SPO2 Monitoring • Measuring the ratio of oxygenated hemoglobin to total hemoglobin • Two different wave lengths of light used • Carboxyhemoglobin gives falsely high reading • Dark skin may give falsely high reading (3%-5%)

  24. Capnography Waveforms

  25. Affecting EtCO2 Increased Ventilation >>> Decreased EtCO2 Decreased Ventilation >>> IncreasedEtCO2 However trapped CO2 will drive up EtCO2 readings. Be alert to a prolonged expiratory phase.

  26. Documentation “He, who does not document will be blamed.” “Shit rolls downhill.” Example: "RSI, laryngoscopy x1, ETT size 7.5, 23cm at teeth, clear breast sound bilateral, positive CO2"

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