1. Advanced Airway Lynn K. Wittwer, MD, MPD Clark County EMS

6. Netter; Atlas of Human Anatomy

8. ANATOMIC CONSIDERATIONS FOR INTUBATION (cont.) Anderson; Grant’s Atlas of Anatomy

11. Correct Placement for intubation (b)

12. Patient in correct position for intubation (sniffing position)

13. Incorrect airway position (hyperflexed)

17. McIntyre; The difficult tracheal intubation

20. DO NO HARM! TAKE AWAY NOTHING FROM THE PATIENT YOU CANNOT REPLACE

22. Airway Evaluation Problem Airway epiglottis Vocal cords

36. Dailey; The airway: emergency management

40. RAPID SEQUENCE INTUBATION INDICATIONS : Need for immediate intubation assumed with failed intubation attempt PROCEDURE: Protect C-Spine prn O 2 100% w/ BVM assist (hyperventilate pt. if possible) Suction prn IV w/ balanced salt solution; EKG *** Cricothyroidotomy equipment available *** Lidocaine 1 mg/kg IV Atropine 0  5 mg IV adults w/ HR <80  (0  01 mg/kg IV All kids <12 ) Etomidate 0  3 mg/kg max 20 mg-5 mg IV Adults and peds >10 yr for sedation. Succinylcholine 1  5 mg/kg IV bolus *** Sellick until intubation successful and ETT cuff inflated *** Perform intubation (once fasciculations stop) If relaxation inadequate in 60-120 secs, repeat Succinylcholine 1  5 mg/kg IV reattempt intubation Confirm placement by auscultation, capnography Secure ETT Ventilate w/ BVM & 100% O 2 Maintain EtCO 2 35-40 mm/Hg If further paralysis required: Vecuronium 0  1 mg/kg Versed 2  5-5 mg IV for sedation  (peds 0  1mg/kg)

41. Airway Management

42. Airway Management

43. Airway Management

48. SURGICAL AIRWAYS Netter; Atlas of Human Anatomy

51. SURGICAL AIRWAYS Anderson; Grant’s Atlas of Anatomy

54. Dailey; The airway: emergency management