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Emergency Emergency Airway Airway Management Management Pat Melanson, MD Pat Melanson, MD

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Page 1: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Emergency Airway Emergency Airway ManagementManagement

Pat Melanson, MDPat Melanson, MD

Page 2: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Safe Safe airway airway managementmanagement

airway evaluationairway evaluation identification of the difficult airwayidentification of the difficult airway assessment of other clinical factorsassessment of other clinical factors selection of the likely most selection of the likely most

successful plan of actionsuccessful plan of action reasonable alternative planreasonable alternative plan

Page 3: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Algorithmic Approach to Airway Algorithmic Approach to Airway ManagementManagement

Have a precompiled plan of airway Have a precompiled plan of airway management ready for implementation management ready for implementation as clinical airway difficulties are as clinical airway difficulties are encounteredencountered

develop a plan and a back-up plandevelop a plan and a back-up plan Practice guidelines for management of Practice guidelines for management of

the difficult airwaythe difficult airway– ASA taskforceASA taskforce– Anesthesiology 78 : 597 - 602, 1993Anesthesiology 78 : 597 - 602, 1993

Page 4: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Emergency AirwayEmergency Airway full stomachfull stomach altered level of consciousnessaltered level of consciousness deteriorating cardiorespiratory deteriorating cardiorespiratory

physiologyphysiology abnormal or distorted upper abnormal or distorted upper

airway anatomyairway anatomy no time for pre-assessment or planno time for pre-assessment or plan

Page 5: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Airway AssessmentAirway Assessment

compromise or threatscompromise or threats potentially difficult airwaypotentially difficult airway

Page 6: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

The Three Pillars of Airway The Three Pillars of Airway ManagementManagement

Patency ( airflow integrity )Patency ( airflow integrity )

Protection against aspirationProtection against aspiration

Assurance of oxygenation and Assurance of oxygenation and ventilationventilation

Page 7: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Indications for Active Indications for Active Airway InterventionAirway Intervention

Patency - relief of obstructionPatency - relief of obstruction Protection from aspirationProtection from aspiration Hypoxic/ hypercapnic respiratory Hypoxic/ hypercapnic respiratory

failurefailure Airway access for pulmonary toilet, Airway access for pulmonary toilet,

drug delivery,therapeutic drug delivery,therapeutic hyperventilationhyperventilation

ShockShock

Page 8: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Clinical Signs of Airway Clinical Signs of Airway

CompromiseCompromise : Patency : Patency

Inspiratory stridorInspiratory stridor Snoring ( pharyngeal obstruction )Snoring ( pharyngeal obstruction ) Gurgling ( foreign matter/ secretions )Gurgling ( foreign matter/ secretions ) Drooling ( epiglottitis )Drooling ( epiglottitis ) Hoarseness ( laryngeal edema/ vc Hoarseness ( laryngeal edema/ vc

paralysis)paralysis) Paradoxical chest wall movementParadoxical chest wall movement Tracheal tugTracheal tug

Page 9: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Clinical Signs of Airway Clinical Signs of Airway

Compromise :Compromise : Protection Protection

Blood in upper airwayBlood in upper airway Pus in upper airwayPus in upper airway persistant vomitingpersistant vomiting

Loss of protective airway reflexesLoss of protective airway reflexes

Page 10: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Clinical Signs of Airway Clinical Signs of Airway Compromise:Compromise:

Oxygenation and Oxygenation and VentilationVentilation

Central cyanosisCentral cyanosis Obtundation and diaphoresisObtundation and diaphoresis rapid shallow respirationsrapid shallow respirations Accessory muscle useAccessory muscle use RetractionsRetractions Abdominal paradoxAbdominal paradox

Page 11: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

The Difficult AirwayThe Difficult Airway

Difficult laryngoscopyDifficult laryngoscopy

Difficult bag-mask ventilationDifficult bag-mask ventilation

Lower airway difficultyLower airway difficulty

Page 12: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Techniques for the Techniques for the Compromised AirwayCompromised Airway

Bag-Valve-Mask VentilationBag-Valve-Mask Ventilation Endotracheal IntubationEndotracheal Intubation Rapid Sequence IntubationRapid Sequence Intubation Alternate techniques for the Alternate techniques for the

difficult airwaydifficult airway

Page 13: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Golden Rules of BaggingGolden Rules of Bagging

“ “ Anybody (Anybody ( almost almost ) can be ) can be oxygenated and ventilated with a oxygenated and ventilated with a bag and a mask “bag and a mask “

The art of bagging should be The art of bagging should be mastered before the art of intubationmastered before the art of intubation

Manual ventilation skill with proper Manual ventilation skill with proper equipment is a fundamental premise equipment is a fundamental premise of advanced airway managementof advanced airway management

Page 14: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Frequent Errors with BVMFrequent Errors with BVM

failure to recognize its importancefailure to recognize its importance forget to bag ( focussed on ETT )forget to bag ( focussed on ETT ) give up on bagging too earlygive up on bagging too early bag but don’t assess efficacybag but don’t assess efficacy failure to assign one person to failure to assign one person to

airway management onlyairway management only

Page 15: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Difficult Airway : BVMDifficult Airway : BVM

Upper airway obstructionUpper airway obstruction Lack of denturesLack of dentures BeardBeard Midfacial smashMidfacial smash facial burns, dressings, scarringfacial burns, dressings, scarring poor lung mechanicspoor lung mechanics

Page 16: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Difficult Airway : BVMDifficult Airway : BVM degree of difficulty from zero to infinitedegree of difficulty from zero to infinite zero = no external effort/internal devicezero = no external effort/internal device one person jaw thrust/ face sealone person jaw thrust/ face seal oropharyngeal or nasopharyngeal AWoropharyngeal or nasopharyngeal AW two person jaw thrust / face sealtwo person jaw thrust / face seal

– both internal airway devicesboth internal airway devices infinite -no patency despite maximal infinite -no patency despite maximal

external effort and full use of OP/NPexternal effort and full use of OP/NP

Page 17: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Difficult Airway : BVMDifficult Airway : BVM

Remove FB - Magill forcepsRemove FB - Magill forceps Triple maneuver if c-spine clear Triple maneuver if c-spine clear

– Head tilt, jaw lift, mouth opening Head tilt, jaw lift, mouth opening

Nasopharyngeal or oropharyngeal Nasopharyngeal or oropharyngeal airwayairway

two-person, four-hand techniquetwo-person, four-hand technique

Page 18: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Prediction of the difficult Prediction of the difficult airway (Intubation)airway (Intubation)

1200 prospectively studied patients1200 prospectively studied patients of 84 patients predicted to have of 84 patients predicted to have

problem, only 22 (25%) actually had a problem, only 22 (25%) actually had a problemproblem

of 43 actual difficult intubations of 43 actual difficult intubations incurred, only 22 (51%) were predictedincurred, only 22 (51%) were predicted

– Latto IP. and Rosen MLatto IP. and Rosen M

Page 19: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Prediction of the difficult Prediction of the difficult airwayairway

history of past airway problems history of past airway problems Careful physical assessmentCareful physical assessment knowledge and experience to knowledge and experience to

overcome the "unpredicted difficult overcome the "unpredicted difficult airway". airway".

learning practical airway management learning practical airway management skills in an environment that is not skills in an environment that is not urgent, stressful or life threateningurgent, stressful or life threatening

Page 20: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other
Page 21: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other
Page 22: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Difficult Airway : Difficult Airway : LaryngoscopyLaryngoscopy

Short thick neckShort thick neck Receding mandibleReceding mandible Buck teethBuck teeth Poor mandibular mobility/ limited Poor mandibular mobility/ limited

jaw openingjaw opening Limited head and neck movement Limited head and neck movement

– ( including trauma )( including trauma )

Page 23: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Difficult Airway : Difficult Airway : LaryngoscopyLaryngoscopy

Tumor, abscess or hematomaTumor, abscess or hematoma BurnsBurns Angioneurotic edemaAngioneurotic edema Blunt or penetrating traumaBlunt or penetrating trauma Rheumatoid arthritis, ankylosing Rheumatoid arthritis, ankylosing

spondylitisspondylitis Congenital syndromesCongenital syndromes Neck surgery or radiationNeck surgery or radiation

Page 24: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Difficult Airway : Difficult Airway : LaryngoscopyLaryngoscopy

3 fingerbreadths mentum to hyoid3 fingerbreadths mentum to hyoid 3 fb chin to thyroid notch3 fb chin to thyroid notch 3 fb upper to lower incisors3 fb upper to lower incisors Head extension and neck flexionHead extension and neck flexion Mallimpadi classificationMallimpadi classification Previous history of difficult Previous history of difficult

intubationintubation

Page 25: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Mallimpadi Classification Mallimpadi Classification ( Tongue to Pharyngeal ( Tongue to Pharyngeal

Size )Size )

I - soft palate, uvula, tonsillar I - soft palate, uvula, tonsillar pillarspillars– 99 % have grade I laryngoscopic view99 % have grade I laryngoscopic view

II - soft palate, uvulaII - soft palate, uvula III - soft palate, base of uvulaIII - soft palate, base of uvula IV - soft palate not visibleIV - soft palate not visible

– 100% grade III or grade IV views100% grade III or grade IV views

Page 26: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Unsuccessful IntubationUnsuccessful Intubation Bag the patientBag the patient Maximize neck flexion/ head extensionMaximize neck flexion/ head extension Move tongue out of line of siteMove tongue out of line of site Maximize mouth openingMaximize mouth opening Look for landmarks and adjust bladeLook for landmarks and adjust blade BURP maneuverBURP maneuver increasing lifting forceincreasing lifting force consider Miller bladeconsider Miller blade Bag the patientBag the patient

Page 27: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Dilemmas:Dilemmas:

Awake or AsleepAwake or Asleep Oral or NasalOral or Nasal Laryngoscopy or Blind IntubationLaryngoscopy or Blind Intubation To Paralyze or NotTo Paralyze or Not

Page 28: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Case #1Case #1

43 year old female, day 12 post SAH43 year old female, day 12 post SAH 5 unclipped cerebral aneurysms5 unclipped cerebral aneurysms vasospasm with left hemiparesisvasospasm with left hemiparesis hydrocephalus with clotted IV drainhydrocephalus with clotted IV drain rising ICP and BPrising ICP and BP decreasing LOCdecreasing LOC ate breakfastate breakfast

Page 29: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

TechniquesTechniques

DL without pharmacologic aidsDL without pharmacologic aids Awake Direct LaryngoscopyAwake Direct Laryngoscopy Awake Blind NasalAwake Blind Nasal Rapid Sequence Intubation (RSI)Rapid Sequence Intubation (RSI) Fiberoptic Fiberoptic Surgical CricothyroidotomySurgical Cricothyroidotomy

Page 30: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Anesthesia Airway MaximsAnesthesia Airway Maxims

the awake airway is the safest to the awake airway is the safest to managemanage

spontaneous breathing is generally spontaneous breathing is generally safer than paralysis with PPV by safer than paralysis with PPV by maskmask

have a low threshold to wake the have a low threshold to wake the patient up and cancel the casepatient up and cancel the case

call for help earlycall for help early

Page 31: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

The “Intubation Reflex “The “Intubation Reflex “

Catecholamine release in response to Catecholamine release in response to laryngeal manipulationlaryngeal manipulation

Tachycardia, hypertension, raised ICPTachycardia, hypertension, raised ICP Attenuated by beta-blockers, fentanylAttenuated by beta-blockers, fentanyl ICP rise possibly attenuated by lidocaineICP rise possibly attenuated by lidocaine Midazolam and thiopental have no effectMidazolam and thiopental have no effect

Page 32: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Rapid Sequence Intubation Rapid Sequence Intubation ::

DefinitionDefinition

The near simultaneous administration The near simultaneous administration of a sedative-hypnotic agent and a of a sedative-hypnotic agent and a neuromuscular blocker in the neuromuscular blocker in the presence of continuous cricoid presence of continuous cricoid pressure to facilitate endotracheal pressure to facilitate endotracheal intubation and minimize risk of intubation and minimize risk of aspirationaspiration

modifications are made depending modifications are made depending upon the clinical scenarioupon the clinical scenario

Page 33: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Rapid Sequence Intubation Rapid Sequence Intubation ::

AdvantagesAdvantages

Optimizes intubating conditions/ Optimizes intubating conditions/ facilitates visualizationfacilitates visualization

Increased rate of successful Increased rate of successful intubationintubation

Decreased time to intubationDecreased time to intubation Decreased risk of aspirationDecreased risk of aspiration Attenuation of hemodynamic and Attenuation of hemodynamic and

ICP changesICP changes

Page 34: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Rapid Sequence Intubation Rapid Sequence Intubation ::

ContraindicationsContraindications

Anticipated difficulty with Anticipated difficulty with endotracheal intubationendotracheal intubation– anatomic distortionanatomic distortion

Lack of operator skill or familiarityLack of operator skill or familiarity inability to preoxygenateinability to preoxygenate

Page 35: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Rapid Sequence Intubation Rapid Sequence Intubation ::

ProcedureProcedure

Pre-intubation assessmentPre-intubation assessment Pre-oxygenatePre-oxygenate Prepare ( for the worst )Prepare ( for the worst ) PremedicatePremedicate ParalyzeParalyze Pressure on cricoidPressure on cricoid Place the tubePlace the tube Post intubation assessmentPost intubation assessment

Page 36: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Pre-oxygenate Pre-oxygenate ( Time - 5 Minutes) ( Time - 5 Minutes)

100 % oxygen for 5 minutes100 % oxygen for 5 minutes 4 conscious deep breaths of 100 % O24 conscious deep breaths of 100 % O2 Fill FRC with reservoir of 100 % O2Fill FRC with reservoir of 100 % O2 Allows 3 to 5 minutes of apneaAllows 3 to 5 minutes of apnea Essential to allow avoidance of Essential to allow avoidance of

baggingbagging If necessary bag with cricoid pressureIf necessary bag with cricoid pressure

Page 37: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Preparation Preparation ( Time - 5 Minutes ) ( Time - 5 Minutes )

ETT, stylet, blades, suction, BVMETT, stylet, blades, suction, BVM Cardiac monitor, pulse oximeter, Cardiac monitor, pulse oximeter,

ETCO2ETCO2 One ( preferably two ) iv linesOne ( preferably two ) iv lines DrugsDrugs Difficult airway kit including cric kitDifficult airway kit including cric kit Patient positioningPatient positioning

Page 38: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Pre-treatment/ Prime Pre-treatment/ Prime ( Time - 2 ( Time - 2

Minutes )Minutes )

Lidocaine 1.5 mg/kg ivLidocaine 1.5 mg/kg iv Defasciculating dose of non-depolarizing Defasciculating dose of non-depolarizing

NMBNMB Beta-blocker or fentanylBeta-blocker or fentanyl Induction agentInduction agent

– Thiopental 3 - 5 mg/kgThiopental 3 - 5 mg/kg– Midazolam 0.1 - 0.4mg/kgMidazolam 0.1 - 0.4mg/kg– Ketamine 1.5 - 2.0 mg/kgKetamine 1.5 - 2.0 mg/kg– Fentanyl 2 - 30 mcg/kgFentanyl 2 - 30 mcg/kg

Page 39: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Paralyze ( Time Zero )Paralyze ( Time Zero )

Succinylcholine 1.5 mg/kg ivSuccinylcholine 1.5 mg/kg iv Allow 45 - 60 seconds for complete Allow 45 - 60 seconds for complete

muscle relaxationmuscle relaxation AlternativesAlternatives

– Vecuromium 0.1 - 0.2 mg/kgVecuromium 0.1 - 0.2 mg/kg– Rocuronium o.6 - 1.2 mg/kgRocuronium o.6 - 1.2 mg/kg

Page 40: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

PressurePressure

Sellick maneuverSellick maneuver initiate upon loss of consciousnessinitiate upon loss of consciousness continue until ETT balloon inflationcontinue until ETT balloon inflation release if active vomitingrelease if active vomiting

Page 41: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Place the Tube Place the Tube ( Time Zero + 45 Secs ) ( Time Zero + 45 Secs )

Wait for optimal paralysisWait for optimal paralysis Confirm tube placement with Confirm tube placement with

ETCO2ETCO2

Page 42: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Post-intubation Post-intubation HypotensionHypotension

Loss of sympathetic driveLoss of sympathetic drive Myocardial infarctionMyocardial infarction Tension pneumothoraxTension pneumothorax Auto-peepAuto-peep

Page 43: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Succinylcholine Succinylcholine : : ContraindicationsContraindications

Hyperkalemia - renal failureHyperkalemia - renal failure Active neuromuscular disease with Active neuromuscular disease with

functional denervation ( 6 days to 6 functional denervation ( 6 days to 6 months)months)

Extensive burns or crush injuriesExtensive burns or crush injuries Malignant hyperthermiaMalignant hyperthermia Pseudocholinesterase deficiencyPseudocholinesterase deficiency Organophosphate poisoningOrganophosphate poisoning

Page 44: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Succinylcholine : Succinylcholine : ComplicationsComplications

Inability to secure airwayInability to secure airway Increased vagal tone ( second dose )Increased vagal tone ( second dose ) Histamine release ( rare )Histamine release ( rare ) Increased ICP/ IOP/ intragastric Increased ICP/ IOP/ intragastric

pressurepressure MyalgiasMyalgias Hyperkalemia with burns, NM diseaseHyperkalemia with burns, NM disease malignant hyperthermiamalignant hyperthermia

Page 45: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Difficult Airway KitDifficult Airway Kit

Multiple blades and ETTsMultiple blades and ETTs ETT guides ( stylets, bougé, light wand)ETT guides ( stylets, bougé, light wand) Emergency nonsurgical ventilation Emergency nonsurgical ventilation

( LMA, combitube, TTJV ) ( LMA, combitube, TTJV ) Emergency surgical airway access Emergency surgical airway access

( cricothyroidotomy kit, cricotomes ) ( cricothyroidotomy kit, cricotomes ) ETT placement verificationETT placement verification Fiberoptic and retrograde intubation Fiberoptic and retrograde intubation

Page 46: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Emergency Surgical Emergency Surgical Airway MaximsAirway Maxims

they are usually a bloody mess, they are usually a bloody mess, but ...but ...

a bloody surgical airway is better a bloody surgical airway is better than an arrested patient with a than an arrested patient with a nice looking necknice looking neck

Page 47: Emergency Airway Management Pat Melanson, MD. Safe airway management n airway evaluation n identification of the difficult airway n assessment of other

Case # 2Case # 2

42 year old female42 year old female right Pancoast tumorright Pancoast tumor RUL, RML, RLL collapseRUL, RML, RLL collapse ARDS on leftARDS on left hypoxemic respiratory failurehypoxemic respiratory failure cord compression C7 - T4cord compression C7 - T4


Manchester by Nicole Melanson Adult Category, First … · by Nicole Melanson Adult Category, First Place They went to hear music. ... Inside my niece Bianca’s old room I found

#1 Essential Emergency Airway Care - Airway Preparation

P LA VERDURE PRISCILLA MALLINSON MELANSON · [1630] Priscilla (Mallinson) Melanson, Yorkshire England ... Maine to deliver at Faial Island in the Açores, Madeira and Barbados from

the difficult airway - JOHN MOHLERjohnmohler.com/documents/N. Lyon Co. Refresher... · Airway - BBeards OObesity OOlder patients T Toothlessness S Snores or stridor Airway - 19 Difficult

Taylor Melanson

Melanson Heath & Co. Finds No Weaknesses in Hubbardston

Accounting Principle 30S - Homemelansonaccounting.weebly.com/.../chapter_2_notes_1.docx · Web viewElaine Melanson Created Date 06/26/2017 09:51:00 Last modified by Elaine Melanson

AIRWAY MANAGEMENT - cicmwrecks.files.wordpress.com · AIRWAY MANAGEMENT Annelise Kerr 1 AIRWAY MANAGEMENT AIRWAY MANAGEMENT 1 Describe the anatomy of the upper airway, larynx and

HYPERTENSIVE EMERGENCIES Pat Melanson, MD McGill University

Conference Proceedings - Respiratory Care Proceedings Mechanical Insufflation-Exsufflation for Airway Mucus Clearance Douglas N Homnick MD MPH Introduction Cough and Airway Clearance

surroundings in St Margaret’s ay - Paulette Melanson · 2019-02-05 · 1 BID Music e-Magazine, issue 8, 2016 Paulette Melanson – Her Paintings Are All About Optimism I am a landscape

Airway assessment & Recognition of difficult airway

Airway Mini-residency: Intro to Airway Orthodontics

By: Jessica Makrinos, Samantha Melanson & Julienne Reis

The Difficult or Failed Airway Pat Melanson, MD. The Difficult Airway Must be able to assess or anticipate the degree of difficulty Then select method

Emergency Airway and Ventilation—The Difficult Airway

Airway Management. Outline Review of airway anatomy Airway evaluation Mask ventilation Endotracheal intubation The difficult airway

Airway hyperresponsivness Bronchoconstriction Reversible airway obstruction

Special Airway Devices and Techniques for the Difficult or Failed Airway Pat Melanson,MD

BLOOD PRESSURE MANAGEMENT IN ACUTE STROKE Pat Melanson, MD McGill University

About the author - Harold Weisbergjfk.hood.edu/Collection/Weisberg Subject Index Files/M Disk/Melanson Philip/Item 28.pdfAbout the author Philip H. Melanson, 38, was an un-dergraduate

Airway Management recognition of airway obstruction

Zinc supplementation alters airway inflammation and airway

AIRWAY MANAGEMENT- NEONATES (Neonatal Resuscitation) CHAKAFA N K (Clinical Anaesthetist)

ADVANCED AIRWAY MANAGEMENT AND THE DON’T PRACTICE … · n Use Sellick’s maneuver while bagging? Bag Mask Ventilation n Adequate seal n Patent airway –jaw thurst – oral airway

THE DIFFICULT AIRWAY. The Key is to maintain: n Oxygenation n Ventilation

FIRE DISTURBANCE IN THE EVERGLADES ECOSYSTEM Lisa Melanson December 13, 2006

OBSTRUCTIVE DISEASES. Causes of airway narrowing Loss of tethering Airway smooth muscle constriction Airway plugging (mucous, foreign body) Airway edema

Maxx Melanson AICE Media Studies Research 1

Copyright by Michael P. Melanson Jr. 2009

New Initiatives Subcommittee Report Wednesday, July 28th, 2010 Mark Melanson 1

April melanson

Mechanical Insufflation-Exsufflation for Airway … Proceedings Mechanical Insufflation-Exsufflation for Airway Mucus Clearance Douglas N Homnick MD MPH Introduction Cough and Airway

Standards Procedure (Skill) Airway Section Airway: …Standards Procedure (Skill) Airway Section Airway: BIAD-Combitube Clinical Indications for Blind Insertion Airway Device (BIAD)

Basic Emergency Airway Management Pat Melanson,MD