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Airway management strategies in emergency and critical care settings

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Andrew Ferguson
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Airway Management in the Emergency Department and ICU Mehdi Khosravi, MD Pulmonary/CCM Fellow Giuditta Angelini, MD Assistant Professor Jonathan T. Ketzler, MD Associate Professor Douglas B. Coursin, MD Professor Departments of Anesthesiology & Medicine University of Wisconsin, Madison
Global Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Global Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Global Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oxygen Delivery Devices (In order of degree of support) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oxygen Delivery Devices Noninvasive Positive Pressure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Degree of Respiratory Distress ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Temporizing Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Temporizing Measures (cont'd) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oral/Nasal Airways
Indications for Intubation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Underlying Lung Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Anatomy Suggesting Difficult Intubation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Erden V, et al. Brit J Anesth. 2003;91:159-160. Prayer Sign
Mallampati Score ,[object Object],[object Object],[object Object],[object Object],Den Herder, et al. Laryngoscope. 2005;115(4):735-739.
Comorbidities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Induction Agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Induction Agents (cont'd) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neuromuscular Blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rapid Sequence Intubation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Y BAG PEOPLE (Reference #6)
Cricoid Pressure ,[object Object],[object Object],[object Object],Koziol C, et al. AORN. 2000;72(6):1018-1030.
Sniffing Position Align oral, pharyngeal, and laryngeal axes to bring epiglottis and vocal cords into view. Hirsch N, et al. Anesthesiology. 2000;93(5):1366.
Mask Ventilation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laryngoscope Blades and Endotracheal Tubes Miller blade: End of blade should be under epiglottis Mac blade: End of blade should be placed in front of epiglottis in valecula ETT for Fastrach LMA Pediatric uncuffed ETT ETT for blind nasal Standard ETT
Graded Views on Intubation Grade 1: Full glottis visible Grade 2: Only posterior commissure Grade 3: Only epiglottis Grade 4: No glottis structures are visible Yarnamoto K, et al. Anesthesiology. 1997;86(2):316.
Confirmation of Placement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Additional Considerations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
American Society of Anesthesiologists www.asahq.org
Alternative Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Eschman Stylet ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fiberoptic Scope ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Laryngeal Mask Airway (LMA)
LMA Placement ,[object Object],[object Object],[object Object],Martin S, et al. J Trauma Injury, Infection Crit Care. 1999;47(2):352-357.
The Fastrach TM Laryngeal Mask Airway ,[object Object],[object Object],[object Object]
The Light Wand ,[object Object],[object Object],[object Object],[object Object],[object Object]
Retrograde Intubation ,[object Object],[object Object],[object Object],Wesler N, et al. Acta Anaes Scan. 2004;48(4):412-416.
Combitube ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Combitube (cont'd) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tracheostomy ,[object Object],[object Object],[object Object],Sharpe M, et al. Laryngoscope. 2003;113(3):530-536.
Case Scenario #1 ,[object Object],[object Object],[object Object],[object Object]
Case Scenario #1 - Answer ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case Scenario #2 ,[object Object],[object Object],[object Object],[object Object]
Case Scenario #2 - Answer ,[object Object],[object Object],[object Object],[object Object]
Case Scenario #3 ,[object Object],[object Object],[object Object]
Case Scenario #3 - Answer ,[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Airway management strategies in emergency and critical care settings

  • 1. Airway Management in the Emergency Department and ICU Mehdi Khosravi, MD Pulmonary/CCM Fellow Giuditta Angelini, MD Assistant Professor Jonathan T. Ketzler, MD Associate Professor Douglas B. Coursin, MD Professor Departments of Anesthesiology & Medicine University of Wisconsin, Madison
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  • 20. Y BAG PEOPLE (Reference #6)
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  • 22. Sniffing Position Align oral, pharyngeal, and laryngeal axes to bring epiglottis and vocal cords into view. Hirsch N, et al. Anesthesiology. 2000;93(5):1366.
  • 23.
  • 24. Laryngoscope Blades and Endotracheal Tubes Miller blade: End of blade should be under epiglottis Mac blade: End of blade should be placed in front of epiglottis in valecula ETT for Fastrach LMA Pediatric uncuffed ETT ETT for blind nasal Standard ETT
  • 25. Graded Views on Intubation Grade 1: Full glottis visible Grade 2: Only posterior commissure Grade 3: Only epiglottis Grade 4: No glottis structures are visible Yarnamoto K, et al. Anesthesiology. 1997;86(2):316.
  • 26.
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  • 28. American Society of Anesthesiologists www.asahq.org
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  • 32. The Laryngeal Mask Airway (LMA)
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