airway management overview

Airway Management Algorithms

WFA Clinical Education Team

Advanced Airway

Management:

The Need to Know Information



Optimal First Intubation Attempt

• Sniffing/ramped position(if no C spine injury)

• Straight to cuff stylet <35◦

• Jaw thrust (by assistant)

• Reduce cricoid force (by assistant)

• External laryngeal manipulation

Missed First Intubation Attempt (Acknowledge Difficult Airway)

• Get help

• Bougie

• Change head position

• Change device

Missed Second Intubation Attempt

• Change blade

• Change person

• Change device

• Reduce C-spine precautions

Missed Third Intubation Attempt

(Acknowledge Missed Airway)

Extraglottic Airway (EAD)

Surgical Airway

EAD Failure

BVMV if Hypoxic

BVMV if Hypoxic

Airway 911 Multiple Attempts Intubation Flow Chart (Adapted)

If Unable to Maintain Saturations with Optimal BVMV

(Acknowledge Missed

Airway)



The Spectrum of Airway

Management

Position of comfort Awake

Supplemental oxygen

NIPPV

Bag- valve-mask

“assisted “ respirations

Nasopharyngeal airway

Oropharyngeal airway

Bag-mask-valve

ventilation

Extraglottic airway

Endotracheal

intubation

Surgical airway Nearly Dead



Airway Definitions

Difficult Airway

1. Predicted to be difficult (LEMONS, RODS) OR

2. Proves to be difficult (more than ONE attempt required)

Missed Airway

1. The provider is unable to intubate within three attempts OR

2. Critical oxygenation cannot be maintained at any time

Crash Airway

1. Patient is “dead” (cardiac arrest or respiratory arrest) OR

2. Patient is “nearly dead” (agonal respirations)



Difficult Bag Mask Ventilation

MOANS

M = Mask seal

O = Obesity/Obstruction

A = Age

N = No teeth

S = Stiff/Snoring



Optimal Bag Valve Mask Ventilations

(BVMV)

2 People One to ventilate, One to hold the Mask

2 Airways NPA +OPA 2 Fingers For cricoid pressure 2 Inches Head elevation to sniffing Position 2 Seconds Slow ventilations

2 PSI Minimum pressure for chest rise



Difficult Extraglottic Device

RODS

R = Restricted mouth opening

O= Obstruction

D= Disrupted or distorted airway

S= Stiff lungs or cervical spine



Difficult Intubation

LEMONS

L = Look externally

E = Evaluate 3-2-3 rule

M =Mallampati score

O = Obstruction

N = Neck mobility

S = Saturations



Mallampati Views

I II

III IV



Three fingers for the mouth opening

Two fingers from hyoid bone to thyroid cartilage

Three fingers from tip of chin to hyoid bone

3-2-3 Rule



Preparation

SOAP ME

S = Suction

O = Oxygen

A = Airway equipment

� OPAs and NPAs

� Bag valve mask

� ET tubes and stylet

� Laryngoscope handle and blades

� Magill forceps

� Rescue airway devices

P = Pharmacology

ME = Monitoring equipment

� ECG and defibrillator

� Pulse oximeter

� EtCO2 monitor



.

Cormack and Lehane Airway

Grading Scale



Difficult Cricothyrotomy

SHORT

S = Surgery or other airway disruption

H = Hematoma (includes infection/

Abscess)

O = Obesity

R = Radiation distortion

T = Tumour

airway management overview

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