2. Objectives Name the major components of the upper and lower airways Describe the functions of the upper and lower airways Describe the process of ventilation Describe the process of respiration Identify the S.A.L.T.™ device Demonstrate use of the S.A.L.T.™ device Explain the SMO for the S.A.L.T.™ device
3. Upper and Lower Airways
4. Upper Airway Anatomy
5. Upper Airway System
6. Lower Airway Anatomy
7. Ventilation & Respiration
8. Alveolar Function
9. Supraglottic AirwayLaryngopharangeal Tube “The S.A.L.T.™ is a unique single patient use oropharyngeal airway which can be utilized to facilitate blind, endotracheal intubation. The S.A.L.T.™ can also be utilized to reduce accidental endotracheal tube extubation.”
10. Using the S.A.L.T.™ Device
11. Standing Medical Order* A. Open Airway 1. Manual maneuvers 2. Clear obstructions using the appropriate techniques/suction 3. If necessary, insert appropriate airway device to maintain the airway (i.e. oropharyngeal, nasopharyngeal, endotrach eal tube, S.A.L.T. ™, Combi-tube/King Airway, cricothyrotomy)*The following SMO is provided as an example only. Check with your Medical Director for the current Airway Management SMOat your service.
12. Standing Medical Order 4. Intubate any unconscious patient without a gag reflex a. monitor patient’s pulse oximetry and cardiac rhythm at all times to prevent unrecognized hypoxia b. hyper oxygenate prior to intubation attempt c. if not able to place tube within 30 sec., withdraw, hyper oxygenate, and re-attempt d. verify placement using Ambu tube check device, observing appropriate chest rise, end tidal CO2 monitoring, and auscultation of breath sounds e. orotracheal or nasotracheal intubation as indicated f. secure tube with ET tube holder (pediatric – use tape) g. in the cardiac arrest situation, initial airway management should be completed with manual maneuvers, & simple adjuncts.
13. Standing Medical Order 5. After two unsuccessful attempts at intubation by direct laryngoscopy, hyper oxygenate the patient, place S.A.L.T. ™ adjunct, hyper oxygenate, then intubate through the S.A.L.T. ™. The S.A.L.T. ™ is only indicated in patients for whom 6.5mm through 9.0mm ETT is appropriate. 6. Nasotracheal intubation and nasal airways should be avoided in the patient with facial trauma, or suspected basal skull fracture. 7. Extreme caution should be exercised in any patient experiencing significant head injury, or with signs of rising intracranial pressure.
14. Standing Medical Order 8. With suspected head injuries, administer Lidocaine 1.5 mg/kg prior to ETT intubation to help prevent rise in ICP. 9. For any patient with a GCS < 8, complete endotracheal intubation 10. Only if necessary, in the unusually difficult intubation, and when the patient can not otherwise be oxygenated by basic life support measures, consider giving Versed (or valium) 5 mg IVP + Morphine Sulfate 2 mg IVP to facilitate intubation per Medication Facilitated Intubation Standing Order.
15. Standing Medical Order 11. A Combi-tube/King Airway should be used if attempts at intubation with the S.A.L.T. ™ are unsuccessful. For EMT-I’s, the Combi-tube/King Airway is the advanced airway for utilization. The Combi-tube/King Airway is contraindicated in the following: a. patients under 5 feet in height or over 6’4” in height b. patients who are less than 16 years of age c. patients who weigh less than 90 lbs d. patients who have known esophageal disease e. patients who have ingested caustic substances
16. Objectives Review Name the major components of the upper and lower airways Describe the functions of the upper and lower airways Describe the process of ventilation Describe the process of respiration Identify the S.A.L.T.™ device Demonstrate use of the S.A.L.T.™ device Explain the SMO for the S.A.L.T.™ device
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