Emergent Airway Management
-
Upload
clinspirity -
Category
Health & Medicine
-
view
104 -
download
0
description
Transcript of Emergent Airway Management
![Page 1: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/1.jpg)
2013
![Page 2: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/2.jpg)
Agenda:Agenda:Agenda:Agenda:
• Airway Anatomy Adult vs. Pediatric• Review of basic equipment• Approach to the Difficult Airway• RSI• Post-Intubation Management• Ventilator Settings• The Crashing Asthmatic
• Airway Anatomy Adult vs. Pediatric• Review of basic equipment• Approach to the Difficult Airway• RSI• Post-Intubation Management• Ventilator Settings• The Crashing Asthmatic
![Page 3: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/3.jpg)
Important take home points
![Page 4: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/4.jpg)
The search for the epiglottis
![Page 5: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/5.jpg)
Are kids Are kids just just small small adults?adults?
Are kids Are kids just just small small adults?adults?
![Page 6: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/6.jpg)
![Page 7: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/7.jpg)
![Page 8: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/8.jpg)
![Page 9: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/9.jpg)
![Page 10: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/10.jpg)
![Page 11: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/11.jpg)
• ExternallyExternally– Larger head/occiput– Head flexes forward and can obstruct
• InternallyInternally– Intra-oral tongue – Large, floppy epiglottis
• ExternallyExternally– Larger head/occiput– Head flexes forward and can obstruct
• InternallyInternally– Intra-oral tongue – Large, floppy epiglottis
![Page 12: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/12.jpg)
• Further differences– “Pinker” vocal cords worsen visualization
– Different location of narrowest point• Peds cuffed tubes?
– Smaller cricothyroid membrane• No surgical crics in children
• Further differences– “Pinker” vocal cords worsen visualization
– Different location of narrowest point• Peds cuffed tubes?
– Smaller cricothyroid membrane• No surgical crics in children
![Page 13: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/13.jpg)
Other ConsiderationsOther Considerations
•More gastric insufflation with BVM
•Quicker desats during intubation Different• 10 kg will drop to 90% in <4 minutes (vs. 8 for adult)
•Vagal response (not significant)• Consider Pre-treatment with Atropine (though not literature supported and not the standard of care)
•More gastric insufflation with BVM
•Quicker desats during intubation Different• 10 kg will drop to 90% in <4 minutes (vs. 8 for adult)
•Vagal response (not significant)• Consider Pre-treatment with Atropine (though not literature supported and not the standard of care)
![Page 14: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/14.jpg)
10% 10%
80%
![Page 15: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/15.jpg)
Hypoxia and Hypercarbia
Bradycardia
![Page 16: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/16.jpg)
Self ConfidentIf he can, you can
![Page 17: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/17.jpg)
![Page 18: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/18.jpg)
![Page 19: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/19.jpg)
Avoid the “cookie-cutter” approach to every airway you encounter.
![Page 20: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/20.jpg)
Be familiar with your equipment…
![Page 21: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/21.jpg)
What tools do I have ?
![Page 22: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/22.jpg)
![Page 23: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/23.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
• Oxygen and Suction
• BVM / OPA / NPA
• ETT / Bougie / LMA / King LT
• Stylet
• Magill forceps
• End-tidal CO2 monitoring and securing devices
• Surgical Airway Devices
• Oxygen and Suction
• BVM / OPA / NPA
• ETT / Bougie / LMA / King LT
• Stylet
• Magill forceps
• End-tidal CO2 monitoring and securing devices
• Surgical Airway Devices
![Page 24: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/24.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
![Page 25: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/25.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
C-E technique is WRONG
CE
![Page 26: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/26.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
Use the Two Thumbs Downtechnique
![Page 27: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/27.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
![Page 28: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/28.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
OPA NPA
![Page 29: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/29.jpg)
![Page 30: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/30.jpg)
King LT
![Page 31: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/31.jpg)
![Page 32: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/32.jpg)
![Page 33: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/33.jpg)
![Page 34: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/34.jpg)
![Page 35: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/35.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
Endotracheal tube
stylet
![Page 36: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/36.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
Eschmann Stylet, a.k.a “Gum elastic bougie”
![Page 37: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/37.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
MAGILL FORCEPS
LMA
![Page 38: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/38.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway EquipmentLMA – Laryngeal Mask Airway
Are extraglottic airways harmful in cardiac arrest ?
![Page 39: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/39.jpg)
Airway EquipmentAirway EquipmentAirway EquipmentAirway Equipment
“Yellow” = YES
“Purple” = Pathologic
![Page 40: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/40.jpg)
Airway Equipment:Airway Equipment:Airway Equipment:Airway Equipment:
• What equipment do we have in our departments?
• Where is it located?
• What equipment do we have in our departments?
• Where is it located?
![Page 41: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/41.jpg)
![Page 42: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/42.jpg)
![Page 43: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/43.jpg)
Broselow TapeThe
![Page 44: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/44.jpg)
![Page 45: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/45.jpg)
![Page 46: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/46.jpg)
![Page 47: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/47.jpg)
• Can’t Protect Airway
• Can’t Maintain Ventilation / Oxygenation
• Expected Decline in Clinical Status
3 Emergent Indications for Intubation
![Page 48: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/48.jpg)
Gag reflex is absent in up to 37% of population, and is a poor predictor of airway protection
•Can they talk?
•Can they swallow and manage secretions?
Can’t Protect Airway
![Page 49: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/49.jpg)
• SaO2 <90% on High Flow O2 or PaO2<60 on FiO2>40%
• PaCO2 >55 if baseline is normal, or >10 increase from baseline
• Respiratory Rate
Can’t Maintain Ventilation or Oxygenation
![Page 50: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/50.jpg)
• Deterioration/Impending Compromise Transport
• Airway protection during procedures (ie. endoscopy)
Expected Decline in Clinical Status
![Page 51: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/51.jpg)
DEFINITIONSDEFINITIONSDEFINITIONSDEFINITIONS
Rapid Sequence Intubation (RSI)
INDUCTION AGENT
PARALYTIC
UNCONSCIOUSNESS
MOTOR PARALYSIS
![Page 52: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/52.jpg)
DEFINITIONSDEFINITIONSDEFINITIONSDEFINITIONS
Delayed Sequence Intubation (DSI)
DSI consists of the administration of
specific sedative agents, which do not
blunt spontaneous ventilations or airway
reflexes; followed by a period of
preoxygenation before the
administration of a paralytic agent.
![Page 53: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/53.jpg)
CONTRAINDICATIONSCONTRAINDICATIONSCONTRAINDICATIONSCONTRAINDICATIONS
INDICATIONINDICATION
RISKRISK
![Page 54: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/54.jpg)
RSI RATIONALERSI RATIONALERSI RATIONALERSI RATIONALE
Increasedsuccess
Decreasedaspiration
![Page 55: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/55.jpg)
BetterC-spinecontrol
RATIONALE - SecondaryRATIONALE - Secondary
![Page 56: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/56.jpg)
Blunting ↑ in ICP / IOP
RATIONALE - SecondaryRATIONALE - Secondary
![Page 57: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/57.jpg)
Avoid airway trauma
RATIONALE - SecondaryRATIONALE - Secondary
![Page 58: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/58.jpg)
Avoid Avoid airway airway traumatrauma
RATIONALE - SecondaryRATIONALE - Secondary
![Page 59: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/59.jpg)
↓ ↓ PainPain↓ ↓ Discomfort Discomfort ↓ ↓ RecallRecall
![Page 60: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/60.jpg)
Adverse Drug Events
HAZARDSHAZARDS
![Page 61: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/61.jpg)
May force crash airway scenario
HAZARDSHAZARDS
![Page 62: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/62.jpg)
The 7 “P’s”of RSIThe 7 “P’s”of RSIThe 7 “P’s”of RSIThe 7 “P’s”of RSI
PPREPARATION
PPREOXYGENATION
PPRETREATMENT
PPARALYSIS WITH INDUCTION
PPROTECTION AND POSITIONING
PPLACEMENT AND PROOF
PPOST-INTUBATION MANAGEMENT
PPREPARATION
PPREOXYGENATION
PPRETREATMENT
PPARALYSIS WITH INDUCTION
PPROTECTION AND POSITIONING
PPLACEMENT AND PROOF
PPOST-INTUBATION MANAGEMENT
TIME ZEROTIME ZERO
t – 10 minutes
t + 90 seconds
![Page 63: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/63.jpg)
![Page 64: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/64.jpg)
PREPARATIONPREPARATIONt – 10 minutest – 10 minutes
PREPARATIONPREPARATIONt – 10 minutest – 10 minutes
1. EQUIPMENT PRESENT AND WORKING
INCLUDING EQUIPMENT
FOR PLAN “B”
1. EQUIPMENT PRESENT AND WORKING
INCLUDING EQUIPMENT
FOR PLAN “B”
![Page 65: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/65.jpg)
PREPARATIONPREPARATIONt – 10 minutest – 10 minutes
PREPARATIONPREPARATIONt – 10 minutest – 10 minutes
2. Ask yourself: CAN I…
BAGBAG THE PATIENT
TUBETUBE THE PATIENT
CRICCRIC THE PATIENT
2. Ask yourself: CAN I…
BAGBAG THE PATIENT
TUBETUBE THE PATIENT
CRICCRIC THE PATIENT
![Page 66: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/66.jpg)
![Page 67: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/67.jpg)
““Evaluate for signs of Evaluate for signs of a difficult intubationa difficult intubation””
-Obesity-Obesity--
![Page 68: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/68.jpg)
![Page 69: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/69.jpg)
LLook at the general anatomyEEvaluate the 3-3-2 ruleMMallampati scoreOObstructionNNeck mobilitySaturation Reserve
LLook at the general anatomyEEvaluate the 3-3-2 ruleMMallampati scoreOObstructionNNeck mobilitySaturation Reserve
CAN I TUBETUBE THIS PATIENT?
![Page 70: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/70.jpg)
Look at the general anatomyLook at the general anatomy
![Page 71: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/71.jpg)
Evaluate the 3-3-2 rule
![Page 72: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/72.jpg)
Mallampati score
![Page 73: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/73.jpg)
Obstruction
![Page 74: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/74.jpg)
Neck mobility
![Page 75: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/75.jpg)
Saturation Reserve
![Page 76: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/76.jpg)
Saturation Reserve
At 92% the patient’s oxygen saturation falls off a cliff….
![Page 77: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/77.jpg)
CAN I CAN I BAGBAG THIS PATIENT? THIS PATIENT?
Maybe. Maybe Not.
![Page 78: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/78.jpg)
Approximate normal ventilation rates:
• 10 bpm Adult
• 20 bpm Child
• 25 bpm Infant
Approximate normal ventilation rates:
• 10 bpm Adult
• 20 bpm Child
• 25 bpm Infant
VENTILATE (BLS)
Squeeze.....Release - Release
![Page 79: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/79.jpg)
Keep Dentures in when using a BVM
![Page 80: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/80.jpg)
CAN I CAN I CRICCRIC THIS PATIENT?THIS PATIENT?
![Page 81: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/81.jpg)
IndicationsIndications
• ObstructionObstruction
• Facial TraumaFacial Trauma
• Intubation or other Intubation or other alternatives impossiblealternatives impossible
• Trismus (clenching)Trismus (clenching)
• > 8 years old > 8 years old
(for open procedures) (for open procedures)
SURGICAL AIRWAYS
LAST RESORT!LAST RESORT!
![Page 82: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/82.jpg)
DEFense Readiness CONdition
Maximum readiness
Armed Forces ready to deploy and engage in less than 6 hours
Air Force ready to mobilize in 15 minutes
Above normal readiness
![Page 83: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/83.jpg)
Discuss / Feel / See Kit
Mark / Kit Bedside
Inject / Prep / Open & Set KitScalpel in Hand
Perform Cric
![Page 84: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/84.jpg)
Open CricothyrotomyOpen CricothyrotomyOpen CricothyrotomyOpen Cricothyrotomy
![Page 85: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/85.jpg)
1.1. Vertical Incision over membraneVertical Incision over membrane2.2. Pierce membrane in horizontal planePierce membrane in horizontal plane3.3. Open and spread to insert 4.0 or 5.0 Open and spread to insert 4.0 or 5.0
tubetube4.4. Secure tube in place and ventilateSecure tube in place and ventilate
1.1. Vertical Incision over membraneVertical Incision over membrane2.2. Pierce membrane in horizontal planePierce membrane in horizontal plane3.3. Open and spread to insert 4.0 or 5.0 Open and spread to insert 4.0 or 5.0
tubetube4.4. Secure tube in place and ventilateSecure tube in place and ventilate
Open CricothyrotomyOpen CricothyrotomyOpen CricothyrotomyOpen Cricothyrotomy
![Page 86: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/86.jpg)
![Page 87: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/87.jpg)
PREOXYGENATIONPREOXYGENATIONt – t – 55 minutes minutes
PREOXYGENATIONPREOXYGENATIONt – t – 55 minutes minutes
1. “First, do not bag!”
2.Avoid “Sellick’s”
maneuver (cricoid pressure)
1. “First, do not bag!”
2.Avoid “Sellick’s”
maneuver (cricoid pressure)
![Page 88: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/88.jpg)
![Page 89: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/89.jpg)
![Page 90: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/90.jpg)
PREOXYGENATIONPREOXYGENATIONt – t – 55 minutes minutes
PREOXYGENATIONPREOXYGENATIONt – t – 55 minutes minutes
1. Well-fitting mask
2. 8 vital capacity breaths
1. Well-fitting mask
2. 8 vital capacity breaths
![Page 91: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/91.jpg)
PREOXYGENATIONPREOXYGENATIONt – t – 55 minutes minutes
PREOXYGENATIONPREOXYGENATIONt – t – 55 minutes minutes
![Page 92: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/92.jpg)
![Page 93: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/93.jpg)
PREOXYGENATIONPREOXYGENATIONt – t – 55 minutes minutes
PREOXYGENATIONPREOXYGENATIONt – t – 55 minutes minutes
NIV CPAP for Pre-Oxygenation
![Page 94: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/94.jpg)
Summary of Summary of LOADLOADPRETREATMENTPRETREATMENT
Summary of Summary of LOADLOADPRETREATMENTPRETREATMENT
LL idocaine optional
OO piates optional
AA tropine for infants consider for kids < 8
DD efasciculating optional dose
LL idocaine optional
OO piates optional
AA tropine for infants consider for kids < 8
DD efasciculating optional dose
![Page 95: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/95.jpg)
DEFASCICULATING DOSEDEFASCICULATING DOSE1/10 1/10 th th the RSI dosethe RSI dose
DEFASCICULATING DOSEDEFASCICULATING DOSE1/10 1/10 th th the RSI dosethe RSI dose
Traditional Indications
1. Blunt rise in ICP
2. Decrease risk of aspiration
3. Prevent muscular pain
Traditional Indications
1. Blunt rise in ICP
2. Decrease risk of aspiration
3. Prevent muscular pain
![Page 96: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/96.jpg)
PRETREATMENTPRETREATMENTt – 3 minutest – 3 minutes
PRETREATMENTPRETREATMENTt – 3 minutest – 3 minutes
If you’re going to give these drugs:
…at least give them some time to circulate (3 minutes)
If you’re going to give these drugs:
…at least give them some time to circulate (3 minutes)
![Page 97: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/97.jpg)
PARALYSIS WITH PARALYSIS WITH INDUCTIONINDUCTION
Time Time ““00””
PARALYSIS WITH PARALYSIS WITH INDUCTIONINDUCTION
Time Time ““00””INDUCTION AGENTS
EtomidateEtomidate
Ketamine
Propafol
Midazolam
INDUCTION AGENTS
EtomidateEtomidate
Ketamine
Propafol
Midazolam
PARALYTIC AGENTS
DEPOLARIZINGDEPOLARIZING
Succinylcholine
NON-DEPOLARIZINGNON-DEPOLARIZING
Vecuronium Rocuronium
PARALYTIC AGENTS
DEPOLARIZINGDEPOLARIZING
Succinylcholine
NON-DEPOLARIZINGNON-DEPOLARIZING
Vecuronium Rocuronium
+
![Page 98: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/98.jpg)
PARALYSIS WITH PARALYSIS WITH INDUCTIONINDUCTION
Time Time ““00””
PARALYSIS WITH PARALYSIS WITH INDUCTIONINDUCTION
Time Time ““00””
Sedation then Paralysis
![Page 99: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/99.jpg)
PARALYSIS WITH PARALYSIS WITH INDUCTIONINDUCTION
Time Time ““00””
PARALYSIS WITH PARALYSIS WITH INDUCTIONINDUCTION
Time Time ““00””
Use of Apneic oxygenation
![Page 100: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/100.jpg)
EtomidateEtomidateEtomidateEtomidate
– Rapid onset/offset
– Minimal hemodynamic and respiratory effects
– Pediatrics – not approved for patients under 10
– Rapid onset/offset
– Minimal hemodynamic and respiratory effects
– Pediatrics – not approved for patients under 10
![Page 101: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/101.jpg)
SuccinylcholineSuccinylcholineSuccinylcholineSuccinylcholine
• When: Immediately after Etomidate
• Onset: Rapid, usually 30-90 secs
• Duration: Short acting, 3-5 mins
• When: Immediately after Etomidate
• Onset: Rapid, usually 30-90 secs
• Duration: Short acting, 3-5 mins
![Page 102: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/102.jpg)
When Sux Really When Sux Really ““SucksSucks””CONTRAINDICATIONSCONTRAINDICATIONS
When Sux Really When Sux Really ““SucksSucks””CONTRAINDICATIONSCONTRAINDICATIONS
1. HYPERKALEMIAHYPERKALEMIARENAL FAILURERHABDOMYOLYSIS
2. RECEPTOR UPREGULATIONRECEPTOR UPREGULATIONSUBACUTE BURNS (>1 day)SUBACUTE DENERVATING DISORDERHISTORY OF MALIGNANT HYPERTHERMIA
1. HYPERKALEMIAHYPERKALEMIARENAL FAILURERHABDOMYOLYSIS
2. RECEPTOR UPREGULATIONRECEPTOR UPREGULATIONSUBACUTE BURNS (>1 day)SUBACUTE DENERVATING DISORDERHISTORY OF MALIGNANT HYPERTHERMIA
![Page 103: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/103.jpg)
SUX IS STILL KINGSUX IS STILL KINGSUX IS STILL KINGSUX IS STILL KING
![Page 104: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/104.jpg)
SUXSUX versusversus ROCROCSUXSUX versusversus ROCROC
45 seconds ONSET 1 minute
9 minutes DURATION 45 minutes
45 seconds ONSET 1 minute
9 minutes DURATION 45 minutes
1 mg/kg1-1.5 mg/kg
![Page 105: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/105.jpg)
PROTECTION AND POSITIONINGPROTECTION AND POSITIONING t + 20 secondst + 20 seconds
PROTECTION AND POSITIONINGPROTECTION AND POSITIONING t + 20 secondst + 20 seconds
May NOT be helpful
![Page 106: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/106.jpg)
Positioning:Positioning:MedicalMedicalvs.vs.TraumaTrauma
Positioning:Positioning:MedicalMedicalvs.vs.TraumaTrauma
![Page 107: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/107.jpg)
C Spine PrecautionsC Spine Precautions
![Page 108: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/108.jpg)
C Spine PrecautionsC Spine Precautions
![Page 109: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/109.jpg)
Positioning Adult vs PediPositioning Adult vs PediPositioning Adult vs PediPositioning Adult vs Pedi
![Page 110: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/110.jpg)
![Page 111: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/111.jpg)
![Page 112: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/112.jpg)
![Page 113: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/113.jpg)
Cormack & Lehane GradingCormack & Lehane GradingCormack & Lehane GradingCormack & Lehane Grading
![Page 114: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/114.jpg)
SweepSweep LeftLeft
and and
LookLook
Orotracheal Intubation ProcedureOrotracheal Intubation Procedure
![Page 115: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/115.jpg)
![Page 116: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/116.jpg)
AdultAdult vs vs PediPedi AdultAdult vs vs PediPedi
Normal TracheaNormal Trachea
![Page 117: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/117.jpg)
PLACEMENT AND PROOFPLACEMENT AND PROOF t + 45 secondst + 45 seconds
PLACEMENT AND PROOFPLACEMENT AND PROOF t + 45 secondst + 45 seconds
![Page 118: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/118.jpg)
POST-INTUBATION POST-INTUBATION MANAGEMENT MANAGEMENT t + 90 secondst + 90 seconds
POST-INTUBATION POST-INTUBATION MANAGEMENT MANAGEMENT t + 90 secondst + 90 seconds
![Page 119: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/119.jpg)
More to come next month……….More to come next month……….
![Page 120: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/120.jpg)
POST-INTUBATION MANAGEMENTPOST-INTUBATION MANAGEMENT t + 90 secondst + 90 seconds
POST-INTUBATION MANAGEMENTPOST-INTUBATION MANAGEMENT t + 90 secondst + 90 seconds
CONFIRM PLACEMENT
&SECURE
TUBE
CONFIRM PLACEMENT
&SECURE
TUBE
![Page 121: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/121.jpg)
Capnography
![Page 122: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/122.jpg)
Post-intubation CXR
![Page 123: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/123.jpg)
INTUBATION HURTS!INTUBATION HURTS!INTUBATION HURTS!INTUBATION HURTS!And it keeps on hurting once the tube is in…And it keeps on hurting once the tube is in…
![Page 124: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/124.jpg)
POST-INTUBATION MANAGEMENTPOST-INTUBATION MANAGEMENT
Achieve Adequate Analgesia and Sedation
![Page 125: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/125.jpg)
POST-INTUBATION MANAGEMENTPOST-INTUBATION MANAGEMENT
Raise the Head of the Bed to at Least 30°
![Page 126: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/126.jpg)
Confirm Lung Protective Vent Settings
POST-INTUBATION MANAGEMENTPOST-INTUBATION MANAGEMENT
• Mode AC• VT 6-8 cc/kg• Rate 12-16• PEEP 5• FiO2 100% then titrate down
Standard Ventilator Settings
![Page 127: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/127.jpg)
POST-INTUBATION MANAGEMENTPOST-INTUBATION MANAGEMENT
Continuous waveform ETCO2
NG / OG tubeEmpty the stomach to reduce the chances of aspiration and to improve lung mechanics
![Page 128: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/128.jpg)
POST-INTUBATION MANAGEMENTPOST-INTUBATION MANAGEMENT
Nebulizers/MDIIf they were intubated for reactive airway disease, then they need frequent nebs
![Page 129: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/129.jpg)
Acute Deterioration Acute Deterioration after Intubationafter IntubationAcute Deterioration Acute Deterioration after Intubationafter Intubation
D.O.P.E.SD.O.P.E.S: :
DDisplacementisplacement
OObstructionbstruction
PPneumothoraxneumothorax
EEquipment failurequipment failure
SStacked Breathstacked Breaths
![Page 130: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/130.jpg)
![Page 131: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/131.jpg)
Basics of Ventilator Management
Lung Injury Obstructive Lung Disease
Use as Default
![Page 132: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/132.jpg)
Basics of Ventilator Management
Lung Injury
Lung Protective Management
1. Mode: use A/C (assist control)
![Page 133: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/133.jpg)
Basics of Ventilator Management
Vt IFR
FiO2
PEEP
RR
![Page 134: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/134.jpg)
Basics of Ventilator Management
VtTidal Volume
6-8 cc/kg IBW
![Page 135: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/135.jpg)
Basics of Ventilator Management
IFRInspiratory Flow Rate
= how quickly the breath is delivered
60-80 LPM
![Page 136: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/136.jpg)
Basics of Ventilator Management
RRRespiratory Rate
16-18 BPM
RR = Ventilation
![Page 137: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/137.jpg)
Basics of Ventilator Management
FiO2
PEEP
1. Start @ 100%2. Wait 5 min3. Get ABG4. Drop to 40%
FiO2
Goal: Saturation of 88-95%
![Page 138: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/138.jpg)
Basics of Ventilator Management
FiO2
PEEPStart with 5
Positive End-Expiratory Pressure - PEEP
![Page 139: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/139.jpg)
Basics of Ventilator Management
FiO2
PEEP
FiO2 + PEEP =Oxygenation
![Page 140: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/140.jpg)
Inspiratory Plateau Pressure_________________________________________________
PeakPlateauPlateau Pressure
< 30 cmH2O
Must find and hold Inspiratory Hold buttonVentilator will then display Plateau Pressure
![Page 141: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/141.jpg)
Basics of Ventilator Management
Vt IFR
FiO2
PEEP
RR
![Page 142: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/142.jpg)
Basics of Ventilator Management
Analgesia 1stSedation 2nd
![Page 143: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/143.jpg)
The Crashing AsthmaticThe Crashing Asthmatic
![Page 144: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/144.jpg)
Crashing Asthmatic
SweatyCan’t TalkTachypneicTripoding
![Page 145: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/145.jpg)
Maximal O2 (NRB)Inhaled AlbuterolInhaled AtroventIV SteroidsIV MagnesiumSC TerbutalineEpinephrine drip
Crashing Asthmatic
THE KITCHEN SINK – Maximal Rx
![Page 146: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/146.jpg)
Crashing Asthmatic
BiPAPCPAP
NON-INVASIVE VENTILATION
![Page 147: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/147.jpg)
Too EarlyToo EarlyToo LateToo Late
Crashing Asthmatic
WHEN TO INTUBATE
![Page 148: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/148.jpg)
Crashing Asthmatic
EtomidateSuccinylcholine
GO FAST!GO FAST!
EtomidateSuccinylcholine
GO FAST!GO FAST!
LidocaineKetamineLidocaineKetamine
KEEP IT SIMPLE! OPTIONS...
HOW TO INTUBATEHOW TO INTUBATE
![Page 149: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/149.jpg)
Crashing Asthmatic
Use a Big ETT AGGRESSIVE TOILET
Reason #1 Reason #1 Mucous PlugsMucous Plugs
![Page 150: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/150.jpg)
Crashing AsthmaticCrashing Asthmatic
Reason #2 Reason #2 DehydrationDehydration
IV FLUID BOLUS
![Page 151: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/151.jpg)
Reason #3 Reason #3 Breath StackingBreath Stacking
Crashing AsthmaticCrashing Asthmatic
Squeeze ChestSqueeze Chest Low Vent SettingsLow Vent Settings
![Page 152: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/152.jpg)
Crashing AsthmaticCrashing Asthmatic
Chest TubesChest Tubes
Reason #4Reason #4BarotraumaBarotrauma
![Page 153: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/153.jpg)
Cardiac Arrest Post-IntubationCardiac Arrest Post-Intubation
11 Disconnect ventilatorDisconnect ventilator 22 Squeeze chest Squeeze chest 33 Bilateral chest tubes Bilateral chest tubes 44 Fluid bolus Fluid bolus
11 Disconnect ventilatorDisconnect ventilator 22 Squeeze chest Squeeze chest 33 Bilateral chest tubes Bilateral chest tubes 44 Fluid bolus Fluid bolus
SummarySummary
![Page 154: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/154.jpg)
Crashing AsthmaticCrashing Asthmatic Last Chance………Last Chance………
Anesthetic Gases
![Page 155: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/155.jpg)
ECMO
![Page 156: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/156.jpg)
Extracorporeal Membrane Oxygenation (ECMO)
![Page 157: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/157.jpg)
Pearls
![Page 158: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/158.jpg)
• Can’t see the cords -
…try BURP
• Another attempt needed – …change something
![Page 159: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/159.jpg)
Call for Call for helphelp ! !
![Page 160: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/160.jpg)
Have a backup plan– “Prior planning prevents poor performance”
Have a backup plan– “Prior planning prevents poor performance”
![Page 161: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/161.jpg)
Don’t panic!Don’t panic!
![Page 162: Emergent Airway Management](https://reader038.fdocuments.in/reader038/viewer/2022103115/55648015d8b42a361d8b499a/html5/thumbnails/162.jpg)
Thank you!Thank you!
Mark P. Brady PA-CDept.of Emergency MedicineCambridge Health AllianceCambridge, MA