“life threatening airway obstruction” - foocus.com · airway managemen t: principles and...
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“Life Threatening Airway Obstruction”
Bob Kacmarek PhD, RRTHarvard Medical School
Massachusetts General HospitalBoston, Massachusetts
9-15-18 FOCUS
Conflict of Interest DisclosureRobert M Kacmarek
I disclose the following financial relationships with commercial entities that produce healthcare-related products or services relevant to the content I am presenting:
Company Relationship Content AreaMedtronic Consultant Artifical AirwaysMedtronic Grant Mech VentOrange Med Consultant Mech VentVenner Medical Grant Artificial Airways
Benumof, Airway Management: Principles and Practice Mosby 1996 Benumof, Airway Management: Principles and Practice Mosby 1996
ASA Practice Guildelines; Management of the Difficult Airway
Anesthesiology 2003;98:1269
Mallampati ClassificationGurinder J Anesth 2008:22;38
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Cormack and Lehane Laryngoscopy Grade Gurinder J Anesth 2008:22;38 Rocke Anes
1992;77:67 Mallampati
Score PI
protruding Incisors
SN Short neck
RM receding mandible
ASA Practice Guildelines;
Management of the Difficult
Airway Anesthesiology 2003;98:1269
ASA Practice Guildelines; Management of the Difficult Airway Anesthesiology 2003;98:1269
ASA Practice Guildelines; Management of the Difficult Airway
Anesthesiology 2003;98:1269
ASA Practice Guildelines; Management of the Difficult Airway Anesthesiology 2003;98:1269
3
Benumof, Airway Management: Principles and Practice Mosby 1996 Benumof, Airway Management: Principles and Practice Mosby 1996
Benumof, Airway Management: Principles and Practice Mosby 1996 Benumof, Airway Management: Principles and Practice Mosby 1996
Benumof, Airway
Management: Principles and Practice Mosby 1996
Laryngeal Mask Airway LMR, Intubating LMR
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King Laryngeal Tube
Benumof, Airway Management: Principles and
Practice Mosby 1996
ROGERS Anes
1983;59:569
Ovassapian Fiberoptic Airway Endoscopy in Anes and CC Raven Press 1990
5
Peterson Anes 2005;103:33
Patterns of liabilioty associated with malpractice claims arising from management of the difficult Airway ASA closed claims database, 179 cases between 1985 and 1999 Evaluated period before and after the original ASA difficult airway guidelines published in 1993 Compared 2 period 1985-1991 and 1993-1999
Peterson Anes
2005;103:33
Peterson Anes
2005;103:33
Peterson Anes 2005;103:33
Peterson Anes
2005;103:33
Peterson Anes
2005;103:33
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Kheterpal Anes 2009;110:891
Observational study over a 4 year period Each adult undergoing general anesthesia
Preoperative patient characteristics, detailed airway physical exam and airway outcome were recorded
Primary outcome impossible mask ventilation despite multiple providers, airway adjuncts or neuromuscular blockade
Kheterpal Anes 2009;110:891
Kheterpal Anes 2009;110:891 Kheterpal Anes 2009;110:891
Kheterpal Anes 2009;110:891Liu, Kacmarek Brit J Anes 2013;110;456
Percutaneous transtracheal ventilation (PTV) via a jet ventilator is considered rescue in difficult airway management
Adult lung simulation
1 inch long 14 gauge IV catheter placed into the midpoint of a 150 ml dead space trachea
Catheter directed toward the lung, the month and perpendicular
PEEP values used to simulation airway obstruction
Ventilated by jet and conventional ventilator.
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Liu, Kacmarek Brit J Anes 2013;110;456 Liu, Kacmarek Brit J Anes 2013;110;456
Liu, Kacmarek Brit J Anes 2013;110;456
Liu, Kacmarek Brit J Anes 2013;110;456
Liu, Kacmarek Brit J Anes 2013;110;456ASA Practice Guildelines;
Management of the Difficult Airway Anesthesiology 2003;98:1269
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ASA Practice Guildelines;
Management of the Difficult
Airway Anesthesiology 2003;98:1269
Thank You
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