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Airway Issues
BLS intervention usually good Ensure patent airway Practice good BVM airway management with Oral
or Nasal Airway Adjuncts
Advanced Airway Devices Intubation Rescue Airways Confirmation Methods (Use and Documentation)
Orotracheal Intubation
WhySecuring patent airwayProtects from aspiration
Known IssuesRight mainstem intubationUnrecognized esophageal intubationsDislodged tubes
Orotracheal Intubation
Techniques Non Trauma Inline Trauma
Tools to assist Fiberoptic scopes Bougies Viewmax blades Grandview blades
Confirmation Probably done in most cases, lacks documentation
Nasotracheal Intubation
WhySpontaneously breathing patient Clenched jaw
Known IssuesUse of too small an E.T. TubeHypopharyngeal placementTrauma to airway
Confirmation Methods
“Dave’s Five” End Tidal CO2 OR EDD
Detection Waveform / Numerical Capnography
Visualization Auscultation Measurement at the teeth (or gum line in peds) Chest Rise / Fall Fogging of the tube Skin color and change Pulse Oximetry
Use Multiple Methods (at least five)
Confirmation Methods
Other Apply Cervical Collar following intubation to
maintain head / neck position Secure with commercial device or other methods
Document Include all methods used in your narrative
This should include at least five items
Also document the results Especially capnography and / or colorimetric color change
Recheck of tube placement post movement
Rescue Airways
When are they appropriateAs a Primary Airway;
Due to suspected difficult airway capture based on assessment and anatomical features
Pediatric patients as preferred by Children’sAs a Rescue Airway;
After failed attempts at intubationAfter failed attempt at intubation during the
Sedate to Intubate procedure.
Laryngeal Mask Airway
Why As an alternative to the face mask for achieving and
maintaining control of the airway. LMA™ airways are indicated for use in:
Known or unexpected difficult airways Establishing an airway during resuscitation in the profoundly
unconscious patient with absent gag reflex Known Issues
Multiple sizes, based on weight, match correct syringe with device to inflate cuff
Does not prevent aspiration Improper placement (cuff folded over) EDD is not recommended as a confirmation device with the
LMA Is NOT a medication route for Endotracheal drugs
Combitube
Why Unconscious / unresponsive patients without gag reflex Blind insertion technique Alternative to E.T.T.
Known Issues Two sizes, limited to patients over 4 foot. Obtaining proper seal / placement Ventilating through correct tube Is NOT a medication route for Endotracheal drugs unless placed in
the trachea (i.e. ventilating tube 2) (consult mfg recommendations) Contraindications
Patients with intact gag reflexes Patient's height below 4 feet Patients with known esophageal pathology Patients after ingestion of caustic substances Central-airway obstruction
PTL
Why Unconscious / unresponsive patients without gag reflex Blind insertion technique Alternative to E.T.T.
Known Issues Obtaining proper seal / placement Ventilating through correct tube Is NOT a medication route for Endotracheal drugs unless it is placed
in the trachea (consult manufacturer recommendations) CONTRAINDICATIONS:
Children - under the age of 14 Conscious or semiconscious patients Known caustic poisoning cases Known esophageal disease
King Airway
Why Unconscious / unresponsive patients without gag reflex Blind insertion technique Alternative to E.T.T.
Known Issues Obtaining proper seal / placement Is NOT a medication route for Endotracheal drugs Multiple sizes, based on height, also multiple cuff volumes Contraindications
Responsive patients with an intact gag reflex. Patients with known esophageal disease. Patients who have ingested caustic substances.
Conclusion
Many devices available to providers Be familiar with what you have available to
your organization. Immobilize to maintain head / neck position. Recheck lung sounds and End Tidal CO2
frequently Document device use and at least five
confirmation methods used with results.