burns airway management by gatward
TRANSCRIPT
@jgatward www.ccam.net.au
20%
CH2O
CCl2O
HCl
NH3
SO2HF NO2
H2S
HCN
CO
↓O2
Particulate matter
O-Prostaglandins NO Neutrophils ↓HPV Tissue injury
↑Microvascular permeability
Interstitial fluid and exudate, casts
Airway obstruction and ↓gas exchange
O2
HBO2?
Cytotoxic Hypoxia
Lactate > 10
O2
Inhalational injury
Decreased LOC
Respiratory failure
Circumferential neck burn
>30% BSA
Transport
Stridor
Anterior column
Anterior column
Middle column
Posterior column
The CCAM Approach to LaryngoscopyKnow your enemy
If there is time, assess the airway using the ‘Three-column model’
Choose your weaponsBased on whether there is a posterior, middle or anterior column
problemKnowing which devices need introducers
Prepare your patientEar to sternal notch (sniffing +/- ramping), apnoeic oxygenation,
suctionPrepare your team
Role delineation, drugs, equipment, back-up plans
Stage 1: laryngeal exposure
Epiglottoscopy with suction
Lift epiglottis (direct or indirect)
Lift scope in line with handle
+/- Bimanual laryngoscopy+/- Increased head
elevation
Stage 2: tube/bougie to glottisStraight/McCoy/Polio/Standard Video:
Advance tube/bougie from below into line-of-sight
Introducer optionalAngulated Video:
Tilt device so glottis in top half of monitorAngulated introducer mandatory (non-
channelled)No introducer (channelled blade)
Stage 3: tube into trachea
Withdraw stylet if used+/- 90° Right turn for Rings+/- Bimanual laryngoscopy
+/- 90° Left turn if tube not passing over bougie (Bougie Left Turn = BLT)
CCAM CICO Algorithm Can’t intubate, can’t
oxygenate
Can you identify the cricothyroid membrane?
Scalpel-finger +/- bougieMake horizontal stab incision through cricothyroid membrane, open orifice
with finger +/- bougie, advance cuffed 6.0mm ETT
Digital blunt dissectionMake a longitudinal midline scalpel
neck incision. Use digital blunt dissection. Palpate the cricothyroid
membrane.
VentilateWith bag-valve apparatus
or anaesthetic circuit
YES NO
Inhalational induction?
e-safe-anaesthesia.org
@AnthonyDHolley
@jgatward www.ccam.net.au