Airway Airway ManagementManagement

The Medic One Way…By Zachary Wm. Drathman

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

Equipment

Basic Airway Adjuncts

Cannula 2-6 lpm

Non-rebreather10-15 lpm Bag Valve Mask

Oropharyngal Airway

(OPA)

The Endotracheal Tube

More Tubes

Rescue Devises

King LT-D

Intubating LMA

Eschmann Stylet

Advanced Electronic Devises

Glyde ScopeAirtraq

Handle & Blades

Miller (Straight) Blade

Machintosh (Curved) Blade

Semi-rigid stylet

McGuinty Equine Oral Retractor

Intubation

How to look like a star…

And avoid the parking lot.

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”

Prepare your patient

Lateral alignment False teeth Sniffing position Suction

POSITION YOURSELF

What is the “Sniffing Position?”

An attempt to align the three planes that form the airway.

Three planes in the airway:

Oral axis:The mouth

Pharyngeal axis:Back of the throat

Laryngeal axis:The trachea

Trying to bring the three planes as close to a parallel alignment as possible.

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

I’m hanging on your every

word!

Recognize trouble when it arrives.

Technique Nurse! Wipe my

forehead!

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!

Proper grip on the Scope

Proper body placement

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 Macintosh bladeinto vallecula

Tip is in Velecula

BLADE TIP PLACEMENT

Placement of Miller bladePlacement of Miller bladeunder epiglottisunder epiglottis

Tip supports epiglottis

The Storbakken Mantra

Lips

Teeth Tongue

Epiglottis

Vocal Cords

6 steps to success

1. Open mouth manually2. Lips3. Teeth 4. Tongue5. Epiglottis6. Vocal Cords

Verbalize these steps RELIGIOUSLY!

VISUALIZE ANATOMY

Tongue

False Cords

Epiglottis somewhe

re up there

Gingivitis

VISUALIZE ANATOMY

VISUALIZE ANATOMY

TongueFalse Cords

Epiglottis somewhe

re up there

VISUALIZE ANATOMY

intubation final 13.mpg

LOCATE EPIGLOTTIS

VISUALIZATION

Velecula

Epiglottis

Vocal Cords

Tongue

Complete procedure

Notice utilization of the Ukrainian two fisted method.

intubation final 12.mpg