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Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
Advanced airway
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Advanced airway

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  1. Advanced Airway Lynn K. Wittwer, MD, MPD Clark County EMS
  2. Advanced Airway <ul><li>Anatomic Considerations </li></ul><ul><li>Rapid Sequence induction </li></ul><ul><li>Induction Agents </li></ul><ul><li>Intubation tricks </li></ul>
  3. Indications for Definitive Airway <ul><li>Risk for obstruction </li></ul><ul><li>Neck hematoma </li></ul><ul><li>Laryngeal, tracheal injury/burn </li></ul><ul><li>Stridor </li></ul>Severe closed head injury with need for hyperventilation <ul><li>Risk for aspiration </li></ul><ul><li>Bleeding </li></ul><ul><li>Vomiting </li></ul><ul><li>Inadequate Respiratory Effort’ </li></ul><ul><li>Tachypneal </li></ul><ul><li>Hypoxia </li></ul><ul><li>Hypercarbia </li></ul><ul><li>Cyanosis </li></ul>Severe Maxillofacial fx’s <ul><li>Apnea </li></ul><ul><li>Neuromuscular Paralysis </li></ul><ul><li>Unconscious </li></ul>Unconscious Need for Ventilation Need for Airway Protection
  4. <ul><li>Mouth: </li></ul><ul><ul><li>Tongue : </li></ul></ul><ul><ul><ul><li>variable in size (angioedema) </li></ul></ul></ul><ul><ul><ul><li>attached inferior to epiglottis </li></ul></ul></ul><ul><ul><li>Mandible </li></ul></ul><ul><ul><li>Uvula </li></ul></ul><ul><li>Pharynx </li></ul><ul><ul><li>Tonsils </li></ul></ul><ul><ul><li>Merges with larynx anterior, esophagus posterior </li></ul></ul><ul><ul><li>Epiglottis high long flaccid and narrow in child </li></ul></ul>ANATOMIC CONSIDERATIONS FOR INTUBATION
  5. <ul><li>The Larynx </li></ul><ul><ul><li>High relative to mandible in child </li></ul></ul><ul><ul><li>Cricoid smaller in child, narrow part of airway </li></ul></ul><ul><ul><li>vocal cord narrow part of adult airway </li></ul></ul><ul><ul><li>arytenoid cartilages </li></ul></ul>ANATOMIC CONSIDERATIONS FOR INTUBATION (cont.)
  6. Netter; Atlas of Human Anatomy
  7. <ul><li>Trachea </li></ul><ul><ul><li>12-15 cm. Adult </li></ul></ul><ul><ul><li>4 cm. Newborn </li></ul></ul><ul><ul><li>right mainstem larger,shorter and less angle </li></ul></ul>ANATOMIC CONSIDERATIONS FOR INTUBATION (cont.) Anderson; Grant’s Atlas of Anatomy
  8. ANATOMIC CONSIDERATIONS FOR INTUBATION (cont.) Anderson; Grant’s Atlas of Anatomy
  9. <ul><ul><li>Tube Sizes (Kids) </li></ul></ul><ul><ul><ul><li>Fit through nose </li></ul></ul></ul><ul><ul><ul><li>Age(years)/4 + 4 </li></ul></ul></ul><ul><ul><ul><li>Oral tube length </li></ul></ul></ul><ul><ul><ul><ul><li>Age(years)/2 + 12 cm. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nasal add 3 cm. </li></ul></ul></ul></ul><ul><ul><ul><li>No cuff under 6 to 8 years </li></ul></ul></ul>OTHER CONSIDERATIONS FOR INTUBATION (cont.)
  10. <ul><li>Difficult tubes </li></ul><ul><ul><li>Immobilized trauma patient </li></ul></ul><ul><ul><li>Combative patient </li></ul></ul><ul><ul><li>Children, esp. Infants </li></ul></ul><ul><ul><li>Short neck </li></ul></ul><ul><ul><li>Prominent upper incisors </li></ul></ul><ul><ul><li>Receding mandible </li></ul></ul><ul><ul><li>Limited jaw opening, limited cervical mobility </li></ul></ul><ul><ul><li>Upper airway conditions </li></ul></ul><ul><ul><li>Facial, laryngeal trauma </li></ul></ul>OTHER CONSIDERATIONS FOR INTUBATION (cont.)
  11. Correct Placement for intubation (b)
  12. Patient in correct position for intubation (sniffing position)
  13. Incorrect airway position (hyperflexed)
  14. Rapid Sequence Induction <ul><li>Indications </li></ul><ul><ul><li>Ventilatory failure </li></ul></ul><ul><ul><li>Airway maintenance/protection </li></ul></ul><ul><ul><li>Treatment and evaluation </li></ul></ul><ul><ul><ul><li>neuro resuscitation(hyperventilate) </li></ul></ul></ul><ul><ul><ul><li>shock </li></ul></ul></ul><ul><ul><ul><li>drug overdose </li></ul></ul></ul>
  15. <ul><li>Contraindications </li></ul><ul><ul><li>Cardiac arrest </li></ul></ul><ul><ul><li>Adequate ventilation </li></ul></ul><ul><ul><li>Deeply comatose patient, absent tone </li></ul></ul><ul><ul><li>Post-intubation sedation </li></ul></ul>Rapid Sequence Induction
  16. <ul><li>Contraindications (cont.) </li></ul><ul><ul><li>Intubation likely unsuccessful </li></ul></ul><ul><ul><ul><li>Partially obstructed airway </li></ul></ul></ul><ul><ul><ul><li>Severe facial abnormality(trauma, etc.) </li></ul></ul></ul>Rapid Sequence Induction Whitten; Anyone Can Intubate
  17. McIntyre; The difficult tracheal intubation
  18. <ul><li>Maintain adequate oxygenation </li></ul><ul><li>Airway protection </li></ul><ul><ul><li>Prevent regurgitation, aspiration </li></ul></ul><ul><li>Obtund adverse cardiovascular and ICP response to intubation </li></ul><ul><li>Better early than late </li></ul><ul><li>Hypoxemia and acidosis effects </li></ul>Rapid Sequence Induction
  19. <ul><li>Treatment Algorithm </li></ul><ul><ul><li>Preparation </li></ul></ul><ul><ul><li>Pre-oxygenation( functional reserve capacity) </li></ul></ul><ul><ul><li>Pre-medication </li></ul></ul><ul><ul><li>Sedation </li></ul></ul><ul><ul><li>Cricoid pressure </li></ul></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Intubation </li></ul></ul>Rapid Sequence Induction
  20. DO NO HARM! TAKE AWAY NOTHING FROM THE PATIENT YOU CANNOT REPLACE
  21. <ul><li>Anticipate the difficulties </li></ul><ul><ul><li>Identify in advance the patient who may require RSI </li></ul></ul><ul><ul><li>Identify the patient with anatomic difficulty </li></ul></ul><ul><ul><li>Have sufficient skill and training </li></ul></ul><ul><ul><li>Have a preformulated plan for potential disaster </li></ul></ul>Rapid Sequence Induction
  22. Airway Evaluation Problem Airway epiglottis Vocal cords
  23. <ul><li>Be prepared: </li></ul><ul><ul><li>Competence with all equipment </li></ul></ul><ul><ul><li>Working equipment </li></ul></ul><ul><ul><li>Be prepared for surgical management </li></ul></ul><ul><ul><li>Master the art of bagging </li></ul></ul><ul><ul><li>Have at least one, if not two, working IV lines </li></ul></ul>Rapid Sequence Induction
  24. <ul><li>Equipment: </li></ul><ul><ul><li>Suction, Oxygen </li></ul></ul><ul><ul><li>Laryngoscope, ET Tubes, Stylet </li></ul></ul><ul><ul><li>BVM </li></ul></ul><ul><ul><li>Pharmacologic agents, mixed and ready </li></ul></ul><ul><ul><li>Monitoring equipment </li></ul></ul><ul><ul><ul><li>Continuous cardiac monitoring </li></ul></ul></ul><ul><ul><ul><li>Pulse oximeter (continuous) </li></ul></ul></ul><ul><ul><ul><li>Auto BP (ideal) </li></ul></ul></ul><ul><ul><ul><li>CO2 device (ET confirmation device) </li></ul></ul></ul>Rapid Sequence Induction
  25. <ul><li>Pre-oxygenation: </li></ul><ul><ul><li>Functional residual capacity </li></ul></ul><ul><ul><li>Oxygen 6-10 l/min via snug mask </li></ul></ul><ul><ul><li>Three minutes ideal if spontaneous breathing </li></ul></ul><ul><ul><li>In “crash”, may use RSI agents and O2 by BVM with mandatory Sellick </li></ul></ul>Rapid Sequence Induction
  26. <ul><li>Pre-medication: </li></ul><ul><ul><li>Atropine </li></ul></ul><ul><ul><ul><li>All children under 12 years </li></ul></ul></ul><ul><ul><ul><li>Adults with heart rate 100 or less *** </li></ul></ul></ul><ul><ul><ul><li>Second dose of Succinylcholine </li></ul></ul></ul><ul><ul><ul><li>Dosage: 0.5 to 1.0 mg adult </li></ul></ul></ul><ul><ul><ul><li>Dosage 0.01 to 0.02 mg child (1 mg max) </li></ul></ul></ul><ul><ul><ul><li>Give ideally 2-3 minutes prior to intubation </li></ul></ul></ul>Rapid Sequence Induction
  27. <ul><li>Pre-medication (cont.) </li></ul><ul><ul><li>Lidocaine </li></ul></ul><ul><ul><ul><li>Decrease adrenergic and physiologic response to laryngoscopy and intubation </li></ul></ul></ul><ul><ul><ul><li>Decreases ICP response </li></ul></ul></ul><ul><ul><ul><li>Mucosal anesthesia </li></ul></ul></ul><ul><ul><ul><li>Dosage: 1.0-1.5 mg/kg IV 2-5 minutes prior to intubation </li></ul></ul></ul>Rapid Sequence Induction
  28. <ul><li>Sedation Agents </li></ul><ul><ul><li>Selection of agent(s) </li></ul></ul><ul><ul><ul><li>perfusion state </li></ul></ul></ul><ul><ul><ul><li>presence of head injury </li></ul></ul></ul><ul><ul><ul><li>clinical diagnosis </li></ul></ul></ul><ul><ul><ul><li>Paramedic drug box </li></ul></ul></ul>Rapid Sequence Induction Paralytics Have No Sedative Quality
  29. <ul><li>Selection of Sedative (cont.) </li></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><ul><li>Amnestic and at high dose, anesthetic </li></ul></ul></ul><ul><ul><ul><li>Little cardiovascular depression </li></ul></ul></ul><ul><ul><ul><ul><li>Diazepam </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Slow onset/longer lasting </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>3-5 mg IV (adult) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>0.2 to 0.4 mg/kg (kids) titrate </li></ul></ul></ul></ul></ul>Rapid Sequence Induction
  30. <ul><li>Benzodiazepines (cont.) </li></ul><ul><ul><ul><li>Midazolam </li></ul></ul></ul><ul><ul><ul><ul><li>Rapid onset </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Potent amnestic </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Moderate decrease in ICP </li></ul></ul></ul></ul><ul><ul><ul><ul><li>1-3 mg IV (adult) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>0.1 mg.Kg titrated in kids </li></ul></ul></ul></ul>Rapid Sequence Induction
  31. <ul><li>Selection of Sedative (cont.) </li></ul><ul><ul><li>Narcotics </li></ul></ul><ul><ul><ul><li>Potent analgesics/sedatives </li></ul></ul></ul><ul><ul><ul><li>Rapid onset w/ brief duration </li></ul></ul></ul><ul><ul><ul><li>Effect can be reversed! </li></ul></ul></ul><ul><ul><ul><ul><li>Morphine </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>2-20 mg IV </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>May cause refractory bradycardia/hypotension </li></ul></ul></ul></ul></ul>Rapid Sequence Induction
  32. <ul><li>Selection of Sedative (cont.) </li></ul><ul><ul><li>Butyrophenones: </li></ul></ul><ul><ul><ul><li>Useful as anxiolytics </li></ul></ul></ul><ul><ul><ul><li>May cause EPS </li></ul></ul></ul><ul><ul><ul><li>Minimal cardiac effect </li></ul></ul></ul><ul><ul><ul><ul><li>Haloperidol </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Potentiates effect of narcotics </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>EPS more common </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>2.5-5.0 mg IV/IM </li></ul></ul></ul></ul></ul>Rapid Sequence Induction
  33. Rapid Sequence Induction <ul><li>Selection of Sedative (cont.) </li></ul><ul><ul><li>Etomidate </li></ul></ul><ul><ul><ul><li>Non-barbiturate hypnotic </li></ul></ul></ul><ul><ul><ul><li>Rapid onset of action, short duration </li></ul></ul></ul><ul><ul><ul><li>Does not blunt sympathetic response to intubation </li></ul></ul></ul><ul><ul><ul><li>Dose: </li></ul></ul></ul><ul><ul><ul><ul><li>0.3 mg/kg IV </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>20 mg maximum dose </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Not indicated for peds <10 years </li></ul></ul></ul></ul></ul>
  34. Induction Agents <ul><li>ACh binds to post synaptic receptors causing depolarization … Contraction of muscle </li></ul><ul><li>ACh removed by acetylcholinesterase and by diffusion …. Relaxation of muscle </li></ul>Neuromuscular Junction Dailey; The airway: emergency management
  35. <ul><li>Mechanism of action: </li></ul><ul><ul><li>Nondepolarizers </li></ul></ul><ul><ul><ul><li>Competitive </li></ul></ul></ul><ul><ul><ul><li>Block ACh receptors … paralysis </li></ul></ul></ul><ul><ul><li>Depolarizers </li></ul></ul><ul><ul><ul><li>Noncompetitive </li></ul></ul></ul><ul><ul><ul><li>Persistent stimulation …fasciculations </li></ul></ul></ul><ul><ul><ul><li>Unresponsiveness to ACh….Paralysis </li></ul></ul></ul>Induction Agents
  36. Dailey; The airway: emergency management
  37. <ul><li>Depolarizing </li></ul><ul><ul><li>Succinylcholine </li></ul></ul><ul><ul><ul><li>Vagal effects </li></ul></ul></ul><ul><ul><ul><ul><li>Excessive bronchial secretions </li></ul></ul></ul></ul><ul><ul><ul><li>Negative inotropic and chronotropic, esp. with repeated dose and in children </li></ul></ul></ul><ul><ul><ul><li>Fasciculations (amelioration) </li></ul></ul></ul><ul><ul><ul><li>Malignant hyperthermia? </li></ul></ul></ul><ul><ul><ul><li>Complete paralysis w/in 30-45 sec. Lasting 4-6 min </li></ul></ul></ul><ul><ul><ul><ul><li>1.5 mg/kg IV </li></ul></ul></ul></ul>Induction Agents
  38. <ul><ul><li>Succinylcholine (cont.) </li></ul></ul><ul><ul><ul><li>Metabolized via Cholinesterase </li></ul></ul></ul><ul><ul><ul><ul><li>0.3% defective enzyme </li></ul></ul></ul></ul><ul><ul><ul><li>Contraindications </li></ul></ul></ul><ul><ul><ul><ul><li>Absolute - none </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hyperkalemia </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Renal failure </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Crush injury </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Burns </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Myotonia </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Paraplegia </li></ul></ul></ul></ul></ul>Induction Agents
  39. <ul><li>Non-depolarizing </li></ul><ul><ul><li>Vecuronium </li></ul></ul><ul><ul><ul><li>Minimal cardiovascular effect </li></ul></ul></ul><ul><ul><ul><li>Long duration of action (may exceed 90 mins) </li></ul></ul></ul><ul><ul><ul><li>Shorter onset than Pancuronium </li></ul></ul></ul><ul><ul><ul><li>0.1 mg/kg </li></ul></ul></ul>Induction Agents
  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
  44. <ul><li>Digital Tactile Intubation </li></ul><ul><li>Eschmann </li></ul><ul><li>Lighted stylette </li></ul><ul><li>Fiberscope </li></ul><ul><li>BURP </li></ul>Intubation Tricks
  45. SURGICAL AIRWAYS <ul><li>Cricothyrotomy </li></ul><ul><ul><li>Indications (Identified need for intubation) </li></ul></ul><ul><ul><ul><li>Maxillofacial trauma </li></ul></ul></ul><ul><ul><ul><li>Oropharyngeal obstruction </li></ul></ul></ul><ul><ul><ul><ul><li>Edema </li></ul></ul></ul></ul><ul><ul><ul><ul><li>FBAO </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mass Lesion </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cancer </li></ul></ul></ul></ul><ul><ul><ul><li>Unsuccessful oral/nasal tracheal </li></ul></ul></ul><ul><ul><ul><li>Difficult anatomy </li></ul></ul></ul><ul><ul><ul><li>Massive hemorrhage/regurgitation </li></ul></ul></ul>
  46. SURGICAL AIRWAYS <ul><li>Cricothyrotomy (cont..) </li></ul><ul><ul><li>Contraindications: </li></ul></ul><ul><ul><ul><li>Age <10-12 </li></ul></ul></ul><ul><ul><ul><li>Laryngeal crush injury </li></ul></ul></ul><ul><ul><ul><li>Laryngeal tumor/stricture </li></ul></ul></ul><ul><ul><ul><li>Tracheal transsection </li></ul></ul></ul><ul><ul><ul><li>subglottic stenosis </li></ul></ul></ul><ul><ul><ul><li>Expanding hematoma </li></ul></ul></ul><ul><ul><ul><li>Coagulopathy </li></ul></ul></ul><ul><ul><ul><li>Unfamiliar w/ procedure </li></ul></ul></ul>
  47. SURGICAL AIRWAYS <ul><li>Anatomy: </li></ul><ul><ul><li>Thyroid cartilage </li></ul></ul><ul><ul><li>Cricoid ring </li></ul></ul><ul><ul><li>Cricoid cartilage </li></ul></ul><ul><ul><li>Thyroid gland </li></ul></ul><ul><ul><li>Trachea </li></ul></ul><ul><ul><li>Major vessels </li></ul></ul>
  48. SURGICAL AIRWAYS Netter; Atlas of Human Anatomy
  49. SURGICAL AIRWAYS <ul><li>Procedure: </li></ul><ul><ul><li>Identify thyroid cartilage </li></ul></ul><ul><ul><ul><li>Cricothyroid membrane </li></ul></ul></ul><ul><ul><li>Vertical incision through skin </li></ul></ul><ul><ul><ul><li>Prep prior </li></ul></ul></ul><ul><ul><ul><li>Incise membrane </li></ul></ul></ul><ul><ul><li>Open incision </li></ul></ul><ul><ul><ul><li>Dilator/tracheal hook </li></ul></ul></ul><ul><ul><li>Insert ETT/Trach tube </li></ul></ul><ul><ul><ul><li>Ventilate patient </li></ul></ul></ul>
  50. SURGICAL AIRWAYS <ul><li>Complications: </li></ul><ul><ul><li>Incorrect placement </li></ul></ul><ul><ul><li>Long execution time </li></ul></ul><ul><ul><li>Hemorrhage </li></ul></ul><ul><ul><li>Passage sub Q </li></ul></ul><ul><ul><li>Plugging </li></ul></ul><ul><ul><li>Pneumomediastinum </li></ul></ul><ul><ul><li>Aspiration </li></ul></ul><ul><ul><li>etc. </li></ul></ul>
  51. SURGICAL AIRWAYS Anderson; Grant’s Atlas of Anatomy
  52. SURGICAL AIRWAYS <ul><li>Retrograde Tracheal Intubation (RTI): </li></ul><ul><ul><li>Indications </li></ul></ul><ul><ul><ul><li>Abnormal anatomy </li></ul></ul></ul><ul><ul><ul><ul><li>Pt. W/ epiglottitis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Severe kyphosis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cervical spondylosis </li></ul></ul></ul></ul><ul><ul><ul><li>Trauma </li></ul></ul></ul><ul><ul><ul><li>Reasonable alternative to Surg and Needle Crike </li></ul></ul></ul>
  53. SURGICAL AIRWAYS <ul><li>RTI (cont...): </li></ul><ul><ul><li>Contraindications </li></ul></ul><ul><ul><ul><li>Trismus (w/o paralytic) </li></ul></ul></ul><ul><ul><ul><li>Coagulopathy </li></ul></ul></ul><ul><ul><ul><li>Enlarged thyroid </li></ul></ul></ul><ul><ul><li>Procedure: </li></ul></ul><ul><ul><ul><li>Supplemental O 2 </li></ul></ul></ul><ul><ul><ul><li>Catheter over needle into CTM </li></ul></ul></ul><ul><ul><ul><li>Insert guidewire through catheter </li></ul></ul></ul><ul><ul><ul><li>Visualize guidewire and pass tube </li></ul></ul></ul>
  54. Dailey; The airway: emergency management
  55. SURGICAL AIRWAYS <ul><li>Needle Cricothyrotomy </li></ul><ul><ul><li>Indications </li></ul></ul><ul><ul><ul><li>Same as for any surgical airway </li></ul></ul></ul><ul><ul><ul><li>Considered safer and quicker than surgical crike </li></ul></ul></ul><ul><ul><ul><li>Will not compromise c-spine in trauma pt. </li></ul></ul></ul><ul><ul><li>Contraindications </li></ul></ul><ul><ul><ul><li>Total obstruction at or near the cords </li></ul></ul></ul><ul><ul><li>Complications </li></ul></ul><ul><ul><ul><li>Misdirection </li></ul></ul></ul><ul><ul><ul><li>Puncture tracheal wall </li></ul></ul></ul><ul><ul><ul><li>Local cord damage </li></ul></ul></ul><ul><ul><ul><li>Does not prevent aspiration! </li></ul></ul></ul>
  56. SURGICAL AIRWAYS <ul><li>Needle Cricothyrotomy </li></ul><ul><ul><li>Procedure </li></ul></ul><ul><ul><ul><li>Supplemental O 2 </li></ul></ul></ul><ul><ul><ul><li>Catheter over needle into CTM (at least 14 ga) </li></ul></ul></ul><ul><ul><ul><li>Attach to high pressure O 2 source (50psi) </li></ul></ul></ul><ul><ul><ul><li>Ventilate using valve or “interrupter type device </li></ul></ul></ul>

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