airway management the medic one way… by zachary wm. drathman
TRANSCRIPT
Our Role in Airway Management
Resuscitation:CPR, Intubation, epinephrine, shocks
Trauma: Airway, breathing, circulation
Medical:Airway, breathing, circulation, dysfunction
Room air: HyperventilationCannula: Basic exam, CP, Asthma, Minor Trauma, COPDNRB: CHF, Inhalation, Trauma, OB,
Pneumonia, Anaphylaxis, Severe COPD
BVM: CPR, Intoxicants, Seizure, Diabetic, CHF, Occlusion, Prep for ETT OPA: Just makes “Bagging” easier
Basic Airway Control
Basic Airway Adjuncts
Cannula 2-6 lpm
Non-rebreather10-15 lpm Bag Valve Mask
Oropharyngal Airway
(OPA)
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”
Three planes in the airway:
Oral axis:The mouth
Pharyngeal axis:Back of the throat
Laryngeal axis:The trachea
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
More than 90% of cases involving 3 or more attempts in the ED are ultimately
successfully intubated using laryngoscopy.
More than 90% of cases involving 3 or more attempts in the ED are ultimately
successfully intubated using laryngoscopy.
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.
Do it right the first time!
MANUALLY OPEN THE MOUTH
Use the “scissor” technique.Manually opening the mouth allows control
of the bladeThe 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!
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!
BLADE TIP PLACEMENT
Placement of Miller bladePlacement of Miller bladeunder epiglottisunder epiglottis
Tip supports epiglottis
6 steps to success
1. Open mouth manually2. Lips3. Teeth 4. Tongue5. Epiglottis6. Vocal Cords
Verbalize these steps RELIGIOUSLY!