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Airway Management

Airway Management. The Medic One Way…. By Zachary Wm. Drathman. Our Role in Airway Management. Resuscitation: CPR, Intubation , epinephrine, shocks Trauma: Airway , breathing, circulation Medical: Airway , breathing, circulation, dysfunction. Basic Airway Control.

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Airway Management

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  1. Airway Management The Medic One Way… By Zachary Wm. Drathman

  2. Our Role in Airway Management Resuscitation: CPR, Intubation, epinephrine, shocks Trauma: Airway, breathing, circulation Medical: Airway, breathing, circulation, dysfunction

  3. Basic Airway Control • Room air:Hyperventilation • Cannula:Basic exam, CP, Asthma, Minor Trauma,COPD • NRB:CHF, Inhalation, Trauma, OB, Pneumonia, Anaphylaxis, Severe COPD • BVM: CPR, Intoxicants, Seizure, Diabetic,CHF,Occlusion, Prep for ETT • OPA: Just makes “Bagging” easier

  4. Equipment

  5. Basic Airway Adjuncts Oropharyngal Airway (OPA) Cannula 2-6 lpm Non-rebreather 10-15 lpm Bag Valve Mask

  6. The Endotracheal Tube

  7. More Tubes

  8. Rescue Devises Eschmann Stylet King LT-D Intubating LMA

  9. Advanced Electronic Devises Glyde Scope Airtraq

  10. Handle & Blades

  11. Miller (Straight) Blade

  12. Machintosh (Curved) Blade

  13. Semi-rigid stylet

  14. McGuinty Equine Oral Retractor

  15. Intubation How to look like a star… And avoid the parking lot.

  16. This is a quest for perfection! Every intubation is BIG deal! Assume each intubation will be a difficult intubation. Give yourself every advantage. Control your stress level. Be “surgical”

  17. Prepare your patient • Lateral alignment • False teeth • Sniffing position • Suction POSITION YOURSELF

  18. What is the “Sniffing Position?”

  19. An attempt to align the three planes that form the airway.

  20. Three planes in the airway: • Oral axis: • The mouth • Pharyngeal axis: • Back of the throat • Laryngeal axis: • The trachea

  21. Trying to bring the three planes as close to a parallel alignment as possible.

  22. Patient Positioning Optimal position: Elevate head to align the ear to the sternal notch. Picture patients in respiratory distress: Head & neck forward, sitting upright. Have “pillowing” material available

  23. Recognize trouble when it arrives. I’m hanging on your every word!

  24. Technique Nurse! Wipe my forehead!

  25. Do it right the first time! Most cases of “difficult” laryngoscopy in emergency settings are not truly difficult but instead, poorly performed at first and then subsequently managed with better technique. More than 90% of cases involving 3 or more attempts in the ED are ultimately successfully intubated using laryngoscopy.

  26. Proper grip on the Scope

  27. Proper body placement

  28. MANUALLY OPEN THE MOUTH • Use the “scissor” technique. • Manually opening the mouth allows control of the blade • The mouth tends to be as open as it will get upon insertion of the blade. Opening it wide initially tends to provide greater success because it allows more room to pass the tube. Opening the mouth with the blade is UNACCEPTABLE!

  29. FOCUS ON BLADE TIP • Treat the blade tip like a precision surgical instrument. • You are seeking the epiglotis. • Mac blade: insertion into the velecula. • Miller blade: lifting of the epiglottis. VISUALIZE ANATOMY AS YOU ADVANCE! NOT a pry bar!

  30. BLADE TIP PLACEMENT Tip is in Velecula

  31. BLADE TIP PLACEMENT Tip supports epiglottis

  32. The Storbakken Mantra Lips Epiglottis Vocal Cords Teeth Tongue

  33. 6 steps to success • Open mouth manually • Lips • Teeth • Tongue • Epiglottis • Vocal Cords Verbalize these steps RELIGIOUSLY!

  34. VISUALIZE ANATOMY Tongue False Cords Epiglottis somewhere up there Gingivitis

  35. VISUALIZE ANATOMY

  36. VISUALIZE ANATOMY False Cords Tongue Epiglottis somewhere up there

  37. VISUALIZE ANATOMY

  38. LOCATE EPIGLOTTIS

  39. VISUALIZATION Tongue Velecula Epiglottis VocalCords

  40. Complete procedure • Notice utilization of the Ukrainian two fisted method.

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