1. Chapter Advanced Airway Management Twenty-Nine

3. Anatomy of the Respiratory System

4. Bronchioles and Alveoli

9. Airway Differences between Adults and Children

11. A IRWAY ADJUNCTS

17. Straight blade brings vocal cords into view by lifting epiglottis.

18. Curved blade brings vocal cords into view by lifting vallecula and indirectly lifting epiglottis.

19. Assembly of Laryngoscope Handle and Blade Align identification with bar, press-forward to lock Press To lock

22. Endotracheal Tube

25. Stylet Stylet in Place

28. Use in unresponsive patient who lacks a cough or gag reflex to help prevent regurgitation and aspiration during endotracheal intubation. Sellick’s Maneuver

29. Cricoid Cartilage Surrounds entire trachea, inferior to cricothyroid membrane (depression below thyroid cartilage or Adam’s apple) K EY TERM

30. Location of Cricoid Cartilage

31. Perform Sellick’s maneuver by exerting posterior pressure on cricoid cartilage.

34. Ensure proper ventilation of patient.

35. Assemble, prepare, and test equipment.

36. If trauma is suspected, have rescuer hold head in neutral position. Position patient’s head.

37. Make sure airway structures are aligned.

38. Insert laryngoscope blade into mouth, avoiding contact with teeth.

39. Lift tongue up and to left.

40. Insert blade and lift mandible.

41. Have rescuer apply Sellick’s maneuver. (Bring vocal cords into view.)

42. Visualize glottic opening between vocal cords.

43. Gently insert endotracheal tube (with stylet in place) until cuff passes between vocal cords.

44. Remove laryngoscope and stylet without moving tube. Inflate cuff with 5–10 cc of air.

45. Attach bag-valve resuscitator and ventilate. Observe rise of chest.

46. Confirm placement by auscultating epigastrium and lungs.

49. Colorimetric end-tidal CO 2 detector

50. Esophageal detector device

51. Combined devices check pulse oximetry, ETCO 2 blood pressure, pulse, respiratory rate, and temperature.

52. Tube Placement If correct placement is confirmed, secure tube and continue to ventilate.

56. It cannot be overemphasized that inadvertent esophageal intubation will likely result in death. Because of the magnitude of this complication, tell new EMT-Bs that if at any time, despite the best efforts to properly assess tube placement, they are in doubt of proper tube placement, they should immediately withdraw the tube and manage the airway with basic airway adjuncts. P RECEPTOR P EARL

57. I NFANT AND CHILD INTUBATION

60. Cricoid Cartilage Child and Adult Airways

69. Equipment: BSI

74. Formula for Endotracheal Tube Size 16 + age (years) 4 = Tube size (mm) (Continued) Infant and Child Intubation

78. (Measured from teeth to midtrachea) Pediatric ET Tube Distances

81. Tell new EMT-Bs that ideally a chart should be placed in the airway kit to help them determine what size tube is generally used for a certain age patient. As an alternative, there are commercially available measuring tapes that estimate tube size based on the length of the patient. P RECEPTOR P EARL

84. If trauma is suspected, have rescuer hold head in neutral position. Place head in “sniffing” position.

110. Nasogastric Intubation Infant/Child: Oxygenate patient; prepare and assemble equipment.

111. Measure tube from tip of nose, around ear, to below xiphoid process. Pass lubricated tube downward along nasal floor into stomach.

112. Confirm placement as you inject 10–20 cc air. Listen for bubbling.

113. Aspirate for stomach contents. Secure tube in place.

116. Take BSI precautions! Preoxygenate and ventilate patient.

117. Carefully check equipment. Insert catheter without suction. Use sterile technique.

118. Advance catheter no farther than carina.

119. Apply suction and withdraw catheter in twisting motion.

120. Resume ventilation. (Suctioning should not interrupt ventilation longer than 15 seconds.) Orotracheal Suctioning

121. Nothing is more embarrassing for the EMT-B, or harmful for the patient, than fumbling around to get a suction unit working when the airway is filled with vomit or blood. Remind new EMT-Bs that a working rigid-tip suction catheter is an essential piece of equipment for suctioning the mouth and pharynx, which must be done before orotracheal intubation. P RECEPTOR P EARL

122. Combitubes ®

123. A Dual Lumen Airway

127. Lubricate the Combitube ®

129. Insert the Combitube ® .

131. Combitube ® in place with cuffs inflated.

132. Ventilate through tube #1 (blue tube).

134. If no lung sounds are present and epigastric sounds are heard, ventilate through the shorter tube (tube #2).

135. Laryngeal Mask Airway (LMA)

136. A Laryngeal Mask Airway

139. Inserting the LMA

141. Automatic Transport Ventilators (ATVs)

142. An Automatic Transport Ventilator

144. 1. Explain the procedure of nasogastric tube insertion. 2. Discuss the indications for orotracheal intubation. 3. How and when should the Sellick maneuver be performed? 4. When is an ETC appropriate to use? R EVIEW QUESTIONS