Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Airway Management Essentials

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Learning Objectives

Cognitive

1. Describe the various conditions that cause concern during treatment in the field for critical airway intervention.

2. Discuss the various adjuncts available to maintain an open airway.

3. Describe the proper technique in using each of the adjuncts.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Learning Objectives

Psychomotor1. Demonstrate how to properly use the

various types of airway adjuncts used by your organization.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Key Vocabulary

• Advantage• Alternative• Aspiration• Asthma

• Complication• Disadvantages• Esophagus• Fenestrated

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Key Vocabulary (continued)

• Hypopharynx• Hypoxia• Intubation• Larynx

• Neonatal• Oxygenation• Primary• Risk

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Key Vocabulary (continued)

• Sedated • Skill• Trachea• Ventilation

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Personal Protective Equipment (PPE)

• Always remember the importance of wearing personal protective equipment when working with a patient’s airway.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

ET Airway Management Concerns

Professional literature has begun toquestion the use of endotrachealintubation in the pre-hospital setting.• Increased scene time• Inadequate opportunities to learn

and practice • Poor conditions

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

ET Airway Management

Concerns (continued)

• Prolonged attempts• Unrecognized placement• Adverse outcomes• Available alternatives

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Alternative Airway Management Tools

• Dual-lumen Airway Devices• Two tubes in one• Function whether placed in the esophagus

as intended or placed in the trachea• Placed blindly into the esophagus

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Process for Insertion: Dual Lumen

• Provider determines the patient has no gag reflex and needs ventilatory support.

• Start ventilating patient with the standard bag valve mask.

• Slide dual lumen down the throat to a marked area.

• Inflate two cuffs.• Ventilate the first tube.• Assess for lung inflation.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Process for Insertion: Dual Lumen (continued)

• If no breath sounds, the tube was accidentally placed into the trachea.

• You won’t be able to ventilate the patient through that first tube.

• Switch from one tube to the other tube.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Disadvantages for Dual Lumen Insertion

• Potential for confusion• Only comes in adult sizes• Potential for trauma to the esophagus

or trachea

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Process for Insertion: Laryngeal Mask Airway

Laryngeal Mask Airway (LMA)• A single lumen airway that is designed to

sit in the hypopharynx, above the glottis, covering the openings of the trachea and larynx

• Comes in various sizes, from neonatal to adult

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

LMA

• Became available as a disposable device around 2005

• Widely used in the operating room by physicians

• Sits in the post-ear pharynx• Creates a cuffed seal based on its

design around the glottis opening or around the trachea

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Disadvantages of LMA

• Does not isolate the trachea for ventilation or suctioning

• Does not protect against aspiration• Cannot be used in patients who are

conscious or who have a gag reflex• Does not seat aggressively in the airway • More prone to dislodgement• More prone to some aspiration problems

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Alternative Airway Management Tools

• Supraglottic Airways• Placed in the hypopharynx• Are not designed to enter either the

trachea or esophagus• Designed to provide a patent airway by

keeping the tongue and soft tissue of the upper airway from obstructing airflow

• Directs airflow toward the trachea

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Advantages for a Supraglottic Airway

• Only one tube• Only has one inflation port• Shorter design makes it less likely to

end up in the trachea • May come in adult sizes and children

sizes

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Insertion for a Supraglottic Airway

• Insert blindly.• Insert into airway as far as it will go.• Inflate one cuff and then attempt to

ventilate.• During ventilation of this patient,

start pulling the tube out.• Evaluate for adequate chest rise.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Key Points

• Intubation provides a method to secure an airway, ventilate, and suction.

• Many questions arise regarding the skills needed to intubate successfully.

• Providers have other options for managing airways.

• Each airway management tool requires knowledge of the tool, when to use the tool, and continuous practice using the tool.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Key Points (continued)

• Every airway management method carries advantages and disadvantages.

• Providers must accept their limitations, recognize problems during airway management use, and/or identify when an airway is mismanaged.

• Providers should be capable of moving to alternative airway management tools when necessary.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Summary

• While endotracheal intubation is a definitive means for securing the airway and isolating the trachea for ventilation and suctioning, it is not always feasible.

• Alternatives include dual-lumen airways, laryngeal mask airways, and other supraglottic airways.

• EMS providers must be knowledgeable about each of the options and be able to carefully weigh the risks and benefits of each procedure for every patient.

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

Applications

• Local protocols — • Recent — case review• Lessons of Scenario drill

Q4.10 – October 2010 Airway Management Essentials © Copyright 2010 American Safety and Health Institute

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