airway management anesthesia view
DESCRIPTION
Airway Management Anesthesia View. Andreas Grabinsky, MD Assistant Professor, Dept. of Anesthesiology Program Director and Section Head, Emergency & Trauma Anesthesia Harborview Medical Center. Overview. Airway management in the field Airway management in the hospital Indications - PowerPoint PPT PresentationTRANSCRIPT
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Airway Management Anesthesia View
Andreas Grabinsky, MDAssistant Professor, Dept. of AnesthesiologyProgram Director and Section Head, Emergency & Trauma AnesthesiaHarborview Medical Center
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Overview
•Airway management in the field
•Airway management in the hospital
•Indications
•Priorities
•Problems
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OR Airway Management
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Field Airway Management
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In the OR
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OR Setting
•26 Operating rooms
•> 1.000 cases per month
•13 Anesthesiology Attendings
•26 Residents / CRNA’s
•Start 07:30AM (Wednesday 08:30AM)
•26 potential airways at 07:30AM
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The OR Whiteboard
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What to do ?•Find the Anesthesiologist in charge
•Find the anesthesiologist (covers 2-3 rooms)
•Help out
•Hope you “get the airway”
•Stay in one of the rooms (first rotation)
•Find a “late start room” for another airway (second rotation)
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Learning Goals
•Identify difficult airway
•Proficient bag/mask ventilation
•Use of alternative airway techniques
•Prepare Intubation
•Learn about RSI
•Demonstrate Laryngoscopy / Intubation
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The Intubator
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Airway Priorities
1. Oxygenate2. Ventilate3. Protect Airway
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Airway Management•Spontaneous ventilation
•Assisted mask/bag ventilation
•Controlled mask/bag ventilation
•Intubation + controlled ventilation
•Surgical airway + controlled ventilation
Use the least aggressive means necessary for airway management
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Indications for Intubation
•Insufficient Oxygenation
•Insufficient Ventilation
•Loss of airway protection
•Impending airway problems (CNS, Trauma)
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Preparation
•Oxygen
•Ambu bag with mask
•Suction
•Laryngoscope (working)
•different size ETT
•Suction
•Plan B (Adjuncts)
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Prevention of Failure
•Assess situation
•Decision for specific airway management
•Communicate
•Plan B
•Reassess (change plan, if needed)
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Failure to intubate in the OR
•Use alternative methods
•Get help
•Wake patient up
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Failure to intubate in the Field
•Use alternative methods
•Failure is not an option !
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Prevention of Failure
Do not mess with a perfectly fine airway.
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Publications
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Airway Assessment
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Difficult Airway
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Harborview Specials
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Indications for Intubation
•Insufficient Ventilation
•Insufficient Oxygenation
•Loss of airway protection
•Impending airway problems (CNS, Trauma)
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Training
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Preparation•Oxygen
•Ambu bag with mask
•Suction
•Laryngoscope (working)
•different size ETT
•Suction
•Plan B
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Tools
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Real Men use Miller Blades
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i-gel
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Res-Q-Scope
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Glidescope
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Glidescope
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Glidescope•25 Paramedic students
•Glidescope versus Macintosh 3 blade
•100 intubations in different scenarios on manekin
•Significant better visualized glotic opening with Glidescope
•Same success rate of 76%
•Increased time to intubation with GlidscopeAziz, Michael, Dillman, Dawn, Kirsch, Jeffrey R. and Brambrink, Ansgar(2009)'Video Laryngoscopy with the Macintosh Video Laryngoscope in Simulated Prehospital Scenarios by Paramedic Students',Prehospital Emergency Care,13:2,251 — 255
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Res-Q-Scope•22 US military parmedic (50 manekin and 8
human intubations)
•22 Emergency medicine residents/attending
•20 minutes instruction and 20 minutes training, 3 trials with each device
•Intubation time Res-Q-Scope 25.9 seconds
•Intubation time direct Laryngoscopy 14.6 secondsShawn M. Varney MD , Melissa Dooley MD, Vikhyat S. Bebarta MD ⁎
Faster intubation with direct laryngoscopy vs handheld videoscope in uncomplicated manikin airwaysAmerican Journal of Emergency Medicine (2009) 27, 259–261
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Questions ?