ADVANCED AIRWAY MANAGEMENT
-
comprises a definable series of complex actions ,
each requiring mastery (before , during after) :
>
-
rapidly assess the patient's need for intubation & the urgency of the situation
>
-
determine the best method of airway management to get the best outcome
>
-
decide whether pharmacological agents are indicated which to ,
use , in what order , 3 in what closes
>
-
airway devices proficiently to achieve a definitive airway while minimizing the likelihood of hypoxemia hypercarbia 3
use ,
aspiration
>
-
recognise when the planned airway intervention has failed , quickly s effectively choose's execute an alternative Crescues
technique
WHEN DO WE INITIATE ADVANCED AIRWAY MX ?
-
decision to intubate should be based on 3 fundamental clinical assessments :
1 is there a failure of airway maintenance or protection ?
-
decreased LOC/unconscious patients lose muscle tone & airway reflexes
-
closed airway due to tongue obstruction
-
a common clinical error is to assume that simply because the patient is "breathing on his/her own" ,
the ability to protect the
airway is preserved
-
although spontaneous ventilation may be adequate ,
the patient may be sufficiently obtunded to be at risk for serious
aspiration
-
advanced airway management opens & maintains the airway protects against aspiration
THE GAG (LARYNGEAL) REFLEX
-
it has been widely taught that the gag reflex is a reliable method of evaluating airway protective reflexes
the absence of reflex is neither sensitive nor specific as an indicator of loss of airway protective
a
gag
-
reflexes
the of reflex has similarly not been demonstrated to the of airway
presence a gag ensure presence
=
protection
-
in addition , testing the gag reflex in a supine patient may result in vomiting & possible aspiration as well
as increasing ICP (intercranial pressure)
-
overall , the gag reflex is not recommended for assessment of airway protection or the need for intubation
-
evaluation of the ability to swallow spontaneously to handle normal oropharyngeal secretions is probably
a better measure of the patient's ability to protect the airway
2 is there a failure of ventilation or oxygenation ?
-
if the patient is unable
to ventilate adequately , or if adequate oxygenation cannot be achieved despite the use of supplemental
oxygen ,
then intubation is indicated
-
in such cases, the intubation is being performed to facilitate ventilation oxygenation rather than to establish or protect
the airway
is Cardiac overdose
·
patient not
breathing i e
.
. arrest ,
hypoxia
i
·
patient is breathing but ,
not adequately , leading to . e
. status asthmations
3 What is the anticipated clinical course ?
-
is the patient's condition 3 airway maintenance going to deteriorate because of dynamics progressive changes related to the
presenting condition or because the work of breathing will become overwhelming in the face of satastrophic illness/injury
·
inhalation burns
Status
·
asthmaticus
·
status epilepticus
·
head injuries
CRASH AIRWAY VS RSI
L -
-
the patient is unconscious , near
-
rapid sequence intubation
death ,
with agonal or no respirations -
the patient needs induction paralysis
& no airway reflexes to facilitate intubation
-
expected to be unresponsive to -
golden standard
the stimulation of direct laryngoscopy -
intubation with medication
-
intubation without medication
-
cardiac arrest patients
, AIRWAY EQUIPMENT
LARYNGOSCOPE ENDOTRACHEAL TLIBE
-
consists of a handle blades -
diameter of the patient's pinkie finger is roughly
-
blades are straight (Miller) or curved (Macintosh) the diameter of the tube used
-
blade sizes range from 0-4
-
cuffed tubes > used in adults
-
-
light -
> bulb or fibre optic -
uncuffed tubes >
-
used in children
tube sizes range from 2-9
-
Y
STYLET &BOLIGIE MLIRPHY'S EYE
NEVER TUBE WITH AN EMPTY TUBE !
-
insurance that even if the primary opening is occluded in
stylet ETT
-
: use to manipulate some way ,
Ventilation willstill occur
·
useful in anterior cords -
radio-opaque blue line , to assist with identification on
X-ray
bougie GOLDEN STANDARD
:
left-facing bevel tip :
- -
superior to stylet
· ·
improves the view of the vocal cords during laryngoscopy
used in difficult airway intubations offers a point with which to the vosal cords
narrow part
· ·
·
all airways in pre-hospital settings are ·
increases the diameter of primary opening , making it less
anticipated difficult airways likely that it will be occluded by secretions
OTHER ATTACHMENTS
SUPRAGLOTTIC AIRWAY DEVICES
BACKLIP DEVICE
-
an airway that is inserted into the larynx to maintain
an airway Supply ventilation 3 Oxygenation
-
sits above the vocal cords
-
comprises a definable series of complex actions ,
each requiring mastery (before , during after) :
>
-
rapidly assess the patient's need for intubation & the urgency of the situation
>
-
determine the best method of airway management to get the best outcome
>
-
decide whether pharmacological agents are indicated which to ,
use , in what order , 3 in what closes
>
-
airway devices proficiently to achieve a definitive airway while minimizing the likelihood of hypoxemia hypercarbia 3
use ,
aspiration
>
-
recognise when the planned airway intervention has failed , quickly s effectively choose's execute an alternative Crescues
technique
WHEN DO WE INITIATE ADVANCED AIRWAY MX ?
-
decision to intubate should be based on 3 fundamental clinical assessments :
1 is there a failure of airway maintenance or protection ?
-
decreased LOC/unconscious patients lose muscle tone & airway reflexes
-
closed airway due to tongue obstruction
-
a common clinical error is to assume that simply because the patient is "breathing on his/her own" ,
the ability to protect the
airway is preserved
-
although spontaneous ventilation may be adequate ,
the patient may be sufficiently obtunded to be at risk for serious
aspiration
-
advanced airway management opens & maintains the airway protects against aspiration
THE GAG (LARYNGEAL) REFLEX
-
it has been widely taught that the gag reflex is a reliable method of evaluating airway protective reflexes
the absence of reflex is neither sensitive nor specific as an indicator of loss of airway protective
a
gag
-
reflexes
the of reflex has similarly not been demonstrated to the of airway
presence a gag ensure presence
=
protection
-
in addition , testing the gag reflex in a supine patient may result in vomiting & possible aspiration as well
as increasing ICP (intercranial pressure)
-
overall , the gag reflex is not recommended for assessment of airway protection or the need for intubation
-
evaluation of the ability to swallow spontaneously to handle normal oropharyngeal secretions is probably
a better measure of the patient's ability to protect the airway
2 is there a failure of ventilation or oxygenation ?
-
if the patient is unable
to ventilate adequately , or if adequate oxygenation cannot be achieved despite the use of supplemental
oxygen ,
then intubation is indicated
-
in such cases, the intubation is being performed to facilitate ventilation oxygenation rather than to establish or protect
the airway
is Cardiac overdose
·
patient not
breathing i e
.
. arrest ,
hypoxia
i
·
patient is breathing but ,
not adequately , leading to . e
. status asthmations
3 What is the anticipated clinical course ?
-
is the patient's condition 3 airway maintenance going to deteriorate because of dynamics progressive changes related to the
presenting condition or because the work of breathing will become overwhelming in the face of satastrophic illness/injury
·
inhalation burns
Status
·
asthmaticus
·
status epilepticus
·
head injuries
CRASH AIRWAY VS RSI
L -
-
the patient is unconscious , near
-
rapid sequence intubation
death ,
with agonal or no respirations -
the patient needs induction paralysis
& no airway reflexes to facilitate intubation
-
expected to be unresponsive to -
golden standard
the stimulation of direct laryngoscopy -
intubation with medication
-
intubation without medication
-
cardiac arrest patients
, AIRWAY EQUIPMENT
LARYNGOSCOPE ENDOTRACHEAL TLIBE
-
consists of a handle blades -
diameter of the patient's pinkie finger is roughly
-
blades are straight (Miller) or curved (Macintosh) the diameter of the tube used
-
blade sizes range from 0-4
-
cuffed tubes > used in adults
-
-
light -
> bulb or fibre optic -
uncuffed tubes >
-
used in children
tube sizes range from 2-9
-
Y
STYLET &BOLIGIE MLIRPHY'S EYE
NEVER TUBE WITH AN EMPTY TUBE !
-
insurance that even if the primary opening is occluded in
stylet ETT
-
: use to manipulate some way ,
Ventilation willstill occur
·
useful in anterior cords -
radio-opaque blue line , to assist with identification on
X-ray
bougie GOLDEN STANDARD
:
left-facing bevel tip :
- -
superior to stylet
· ·
improves the view of the vocal cords during laryngoscopy
used in difficult airway intubations offers a point with which to the vosal cords
narrow part
· ·
·
all airways in pre-hospital settings are ·
increases the diameter of primary opening , making it less
anticipated difficult airways likely that it will be occluded by secretions
OTHER ATTACHMENTS
SUPRAGLOTTIC AIRWAY DEVICES
BACKLIP DEVICE
-
an airway that is inserted into the larynx to maintain
an airway Supply ventilation 3 Oxygenation
-
sits above the vocal cords
