Airway Management

GMVEMSC Education Committee

Objectives

Review proper airway managementReview 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

Advanced Airway Devices Intubation Rescue Airways Confirmation Methods (Use and Documentation)

Orotracheal Intubation

WhySecuring patent airwayProtects from aspiration

Known IssuesRight mainstem intubationUnrecognized esophageal intubationsDislodged tubes

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

Nasotracheal Intubation

WhySpontaneously breathing patient Clenched jaw

Known IssuesUse of too small an E.T. TubeHypopharyngeal placementTrauma to airway

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)

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

Rescue Airways

When are they appropriateAs a Primary Airway;

Due to suspected difficult airway capture based on assessment and anatomical features

Pediatric patients as preferred by Children’sAs a Rescue Airway;

After failed attempts at intubationAfter failed attempt at intubation during the

Sedate to Intubate procedure.

Types of Rescue Devices

LMACombitubePTLKing

Laryngeal Mask Airway

http://www.lmana.com/unique.php

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

Combitube

http://www.combitube.org/

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

PTL

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

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

King Airway

http://www.kingsystems.com/

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.

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.

Questions / Discussion