airwaymanagement-09032008

8/21/2019 AirwayManagement-09032008

1/21

Airway Management

GMVEMSC Education Committee


2/21

Objectives

Review proper airway management

Review assessment

Review adjuncts and proper use


3/21

Airway Issues

BS intervention usua!!y good Ensure patent airway

"ractice good BVM airway management wit# Ora!

or $asa! Airway Adjuncts

Advanced Airway %evices Intubation

Rescue Airways

Con&irmation Met#ods '(se and %ocumentation)


4/21

Orotrac#ea! Intubation

*#ySecuring patent airway

"rotects &rom aspiration

+nown IssuesRig#t mainstem intubation

(nrecogni,ed esop#agea! intubations

%is!odged tubes


5/21

Orotrac#ea! Intubation

-ec#ni.ues $on -rauma In!ine -rauma

-oo!s to assist /iberoptic scopes Bougies Viewma0 b!ades

Grandview b!adesCon&irmation

"robab!y done in most cases1 !ac2s documentation


6/21

$asotrac#ea! Intubation

*#ySpontaneous!y breat#ing patient

C!enc#ed jaw

+nown Issues(se o& too sma!! an E3-3 -ube

4ypop#aryngea! p!acement

-rauma to airway


7/21

Con&irmation Met#ods

5%ave6s /ive7 End -ida! CO8 OR E%%

%etection *ave&orm 9 $umerica! Capnograp#y

Visua!i,ation Auscu!tation Measurement at t#e teet# 'or gum !ine in peds) C#est Rise 9 /a!! /ogging o& t#e tube S2in co!or and c#ange "u!se O0imetry

(se Mu!tip!e Met#ods 'at !east &ive)


8/21

Con&irmation Met#ods

Ot#er App!y Cervica! Co!!ar &o!!owing intubation to

maintain #ead 9 nec2 position

Secure wit# commercia! device or ot#er met#ods%ocument

Inc!ude a!! met#ods used in your narrative -#is s#ou!d inc!ude at !east &ive items

A!so document t#e resu!ts Especia!!y capnograp#y and 9 or co!orimetric co!or c#ange

Rec#ec2 o& tube p!acement post movement


9/21

Rescue Airways

*#en are t#ey appropriate As a "rimary Airway:

%ue to suspected di&&icu!t airway capture based

on assessment and anatomica! &eatures"ediatric patients as pre&erred by C#i!dren6s

As a Rescue Airway:

A&ter &ai!ed attempts at intubation A&ter &ai!ed attempt at intubation during t#e

Sedate to Intubate procedure3


10/21

-ypes o& Rescue %evices

MA

Combitube

"-+ing


11/21

aryngea! Mas2 Airway

#ttp;99www3!mana3com9uni.ue3p#p


12/21

aryngea! Mas2 Airway

*#y As an a!ternative to t#e &ace mas2 &or ac#ieving and

maintaining contro! o& t#e airway3 LMA™ airways are indicated &or use in;

+nown or une0pected di&&icu!t airways Estab!is#ing an airway during resuscitation in t#e pro&ound!y

unconscious patient wit# absent gag re&!e0

+nown Issues Mu!tip!e si,es1 based on weig#t1 matc# correct syringe wit#

device to in&!ate cu&& %oes not prevent aspiration Improper p!acement 'cu&& &o!ded over) E%% is not recommended as a con&irmation device wit# t#e

MA Is $O- a medication route &or Endotrac#ea! drugs


13/21


14/21

Combitube

#ttp;99www3combitube3org9


15/21

Combitube

*#y (nconscious 9 unresponsive patients wit#out gag re&!e0 B!ind insertion tec#ni.ue A!ternative to E3-3-3

+nown Issues

-wo si,es1 !imited to patients over < &oot3 Obtaining proper sea! 9 p!acement Venti!ating t#roug# correct tube Is $O- a medication route &or Endotrac#ea! drugs un!ess p!aced in

t#e trac#ea 'i3e3 venti!ating tube 8) 'consu!t m&g recommendations) Contraindications

"atients wit# intact gag re&!e0es "atient=s #eig#t be!ow < &eet "atients wit# 2nown esop#agea! pat#o!ogy "atients a&ter ingestion o& caustic substances Centra!>airway obstruction


16/21

"-

Gettig Pharmaceutical Instrument Company

#ttp;998?@38383?9pt!3#tm!


17/21

"-


+nown Issues

Obtaining proper sea! 9 p!acement Venti!ating t#roug# correct tube Is $O- a medication route &or Endotrac#ea! drugs un!ess it is p!aced

in t#e trac#ea 'consu!t manu&acturer recommendations) CO$-RAI$%ICA-IO$S;

C#i!dren > under t#e age o& ?<

Conscious or semiconscious patients +nown caustic poisoning cases +nown esop#agea! disease


18/21

+ing Airway

#ttp;99www32ingsystems3com9


19/21

+ing Airway


+nown Issues Obtaining proper sea! 9 p!acement Is $O- a medication route &or Endotrac#ea! drugs Mu!tip!e si,es1 based on #eig#t1 a!so mu!tip!e cu&& vo!umes Contraindications

Responsive patients wit# an intact gag re&!e03 "atients wit# 2nown esop#agea! disease3 "atients w#o #ave ingested caustic substances3


20/21

Conc!usion

Many devices avai!ab!e to providers

Be &ami!iar wit# w#at you #ave avai!ab!e to

your organi,ation3

Immobi!i,e to maintain #ead 9 nec2 position3

Rec#ec2 !ung sounds and End -ida! CO8

&re.uent!y

%ocument device use and at !east &ivecon&irmation met#ods used wit# resu!ts3


21/21

Duestions 9 %iscussion

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