airwaymanagement-09032008
TRANSCRIPT
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Airway Management
GMVEMSC Education Committee
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Objectives
Review proper airway management
Review assessment
Review adjuncts and proper use
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Airway Issues
BS intervention usua!!y good Ensure patent airway
"ractice good BVM airway management wit# Ora!
or $asa! Airway Adjuncts
Advanced Airway %evices Intubation
Rescue Airways
Con&irmation Met#ods '(se and %ocumentation)
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Orotrac#ea! Intubation
*#ySecuring patent airway
"rotects &rom aspiration
+nown IssuesRig#t mainstem intubation
(nrecogni,ed esop#agea! intubations
%is!odged tubes
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Orotrac#ea! Intubation
-ec#ni.ues $on -rauma In!ine -rauma
-oo!s to assist /iberoptic scopes Bougies Viewma0 b!ades
Grandview b!adesCon&irmation
"robab!y done in most cases1 !ac2s documentation
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$asotrac#ea! Intubation
*#ySpontaneous!y breat#ing patient
C!enc#ed jaw
+nown Issues(se o& too sma!! an E3-3 -ube
4ypop#aryngea! p!acement
-rauma to airway
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Con&irmation Met#ods
5%ave6s /ive7 End -ida! CO8 OR E%%
%etection *ave&orm 9 $umerica! Capnograp#y
Visua!i,ation Auscu!tation Measurement at t#e teet# 'or gum !ine in peds) C#est Rise 9 /a!! /ogging o& t#e tube S2in co!or and c#ange "u!se O0imetry
(se Mu!tip!e Met#ods 'at !east &ive)
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Con&irmation Met#ods
Ot#er App!y Cervica! Co!!ar &o!!owing intubation to
maintain #ead 9 nec2 position
Secure wit# commercia! device or ot#er met#ods%ocument
Inc!ude a!! met#ods used in your narrative -#is s#ou!d inc!ude at !east &ive items
A!so document t#e resu!ts Especia!!y capnograp#y and 9 or co!orimetric co!or c#ange
Rec#ec2 o& tube p!acement post movement
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Rescue Airways
*#en are t#ey appropriate As a "rimary Airway:
%ue to suspected di&&icu!t airway capture based
on assessment and anatomica! &eatures"ediatric patients as pre&erred by C#i!dren6s
As a Rescue Airway:
A&ter &ai!ed attempts at intubation A&ter &ai!ed attempt at intubation during t#e
Sedate to Intubate procedure3
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-ypes o& Rescue %evices
MA
Combitube
"-+ing
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aryngea! Mas2 Airway
#ttp;99www3!mana3com9uni.ue3p#p
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aryngea! Mas2 Airway
*#y As an a!ternative to t#e &ace mas2 &or ac#ieving and
maintaining contro! o& t#e airway3 LMA™ airways are indicated &or use in;
+nown or une0pected di&&icu!t airways Estab!is#ing an airway during resuscitation in t#e pro&ound!y
unconscious patient wit# absent gag re&!e0
+nown Issues Mu!tip!e si,es1 based on weig#t1 matc# correct syringe wit#
device to in&!ate cu&& %oes not prevent aspiration Improper p!acement 'cu&& &o!ded over) E%% is not recommended as a con&irmation device wit# t#e
MA Is $O- a medication route &or Endotrac#ea! drugs
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Combitube
#ttp;99www3combitube3org9
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Combitube
*#y (nconscious 9 unresponsive patients wit#out gag re&!e0 B!ind insertion tec#ni.ue A!ternative to E3-3-3
+nown Issues
-wo si,es1 !imited to patients over < &oot3 Obtaining proper sea! 9 p!acement Venti!ating t#roug# correct tube Is $O- a medication route &or Endotrac#ea! drugs un!ess p!aced in
t#e trac#ea 'i3e3 venti!ating tube 8) 'consu!t m&g recommendations) Contraindications
"atients wit# intact gag re&!e0es "atient=s #eig#t be!ow < &eet "atients wit# 2nown esop#agea! pat#o!ogy "atients a&ter ingestion o& caustic substances Centra!>airway obstruction
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Gettig Pharmaceutical Instrument Company
#ttp;998?@38383?9pt!3#tm!
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*#y (nconscious 9 unresponsive patients wit#out gag re&!e0 B!ind insertion tec#ni.ue A!ternative to E3-3-3
+nown Issues
Obtaining proper sea! 9 p!acement Venti!ating t#roug# correct tube Is $O- a medication route &or Endotrac#ea! drugs un!ess it is p!aced
in t#e trac#ea 'consu!t manu&acturer recommendations) CO$-RAI$%ICA-IO$S;
C#i!dren > under t#e age o& ?<
Conscious or semiconscious patients +nown caustic poisoning cases +nown esop#agea! disease
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+ing Airway
#ttp;99www32ingsystems3com9
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+ing Airway
*#y (nconscious 9 unresponsive patients wit#out gag re&!e0 B!ind insertion tec#ni.ue A!ternative to E3-3-3
+nown Issues Obtaining proper sea! 9 p!acement Is $O- a medication route &or Endotrac#ea! drugs Mu!tip!e si,es1 based on #eig#t1 a!so mu!tip!e cu&& vo!umes Contraindications
Responsive patients wit# an intact gag re&!e03 "atients wit# 2nown esop#agea! disease3 "atients w#o #ave ingested caustic substances3
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Conc!usion
Many devices avai!ab!e to providers
Be &ami!iar wit# w#at you #ave avai!ab!e to
your organi,ation3
Immobi!i,e to maintain #ead 9 nec2 position3
Rec#ec2 !ung sounds and End -ida! CO8
&re.uent!y
%ocument device use and at !east &ivecon&irmation met#ods used wit# resu!ts3
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Duestions 9 %iscussion