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Icu Emergency Airway Management

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Andrew Ferguson
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ICU Emergency AIRWAY MANAGEMENT Dalhousie Critical Care Lecture Series
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case History ,[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Anatomy….
Airway Exam ,[object Object]
Airway Exam ,[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Anatomy….
 
Airway Exam ,[object Object],[object Object],[object Object]
Cormack-Lehane Laryngeal View
Definition Minimal Sedation -Anxiolysis Conscious sedation is the use of medication to minimally depress the LOC in a patient while allowing the patient to continually and independently maintain a patent A/W and respond appropriately to verbal commands or gentle stimulation. Chet Wyman, University of Maryland School of Medicine
Sedatives In The Ideal World ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],There are no drugs available which achieve these ideals!
Midazolam (Versed®) ,[object Object],[object Object],[object Object]
Midazolam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fentanyl ,[object Object],[object Object],[object Object],[object Object]
Fentanyl ,[object Object],[object Object],[object Object],[object Object],[object Object]
Etomidate ,[object Object],[object Object],[object Object],[object Object]
Etomidate ,[object Object],[object Object],[object Object],[object Object],[object Object]
Topical Anesthesia Each spray = 10 mg of lidocaine Maximum dose = 5 mg/kg i.e. for 70 kg patient =35 sprays!
3 sprays of lidocaine to each location + 3 sprays behind tongue
Airway Management
4 Questions ,[object Object],[object Object],[object Object],[object Object],Murphy et al CJA 2005 52:3
Basic Airway Management ,[object Object],[object Object],[object Object],[object Object]
OPA ,[object Object],[object Object],[object Object]
NPA ,[object Object],[object Object],[object Object]
Mask Ventilation Requires … ,[object Object],[object Object],[object Object],[object Object],[object Object]
2 Handed BVM
Difficult Ventilation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hung and Murphy CJA 2004 51:10
Can I ventilate this patient ?? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Predictors of Difficult Intubation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Merah NA et al CJA 2005 52
Can’t Intubate/Can’t Ventilate or Holy *@#& Phenomenon ,[object Object],[object Object],Benumof JL Airway Management Principles and Practice 1996:124.
Time to intubate . . . ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Position Your Patient ,[object Object],[object Object],[object Object]
What Size Endotracheal Tube ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What Laryngoscope ?
Laryngoscopy
Intubation Confirmation ! ,[object Object],[object Object],[object Object]
 
Airway Adjuncts
Cricoid Pressure ,[object Object],[object Object],[object Object]
Laryngeal Mask Airway ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Bougie ,[object Object],[object Object],[object Object]
Special Cases ,[object Object],[object Object],[object Object],[object Object]
Obesity ,[object Object],[object Object],[object Object],[object Object],[object Object]
Positioning Obese Patients The blue axis = ear to manubrium should be level
Rheumatoid Arthritis ,[object Object],[object Object],[object Object],[object Object]
C1 and C2 Anatomy
 
Head and Neck Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object]
Head and neck masses Epiglottis Glottic opening Supraglottic mass
C-spine Trauma ,[object Object],[object Object],[object Object]
In-line Stabilization
What about the Patient with Pneumonia? ,[object Object]
Answer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Pathophysiology of hypoxic respiratory failurePathophysiology of hypoxic respiratory failure
Pathophysiology of hypoxic respiratory failure
 
Perioperative Optimisation of Coagulation and Haemostasis
Perioperative Optimisation of Coagulation and HaemostasisPerioperative Optimisation of Coagulation and Haemostasis
Perioperative Optimisation of Coagulation and Haemostasis
 
Pulmonary hypertension and the Intensivist
Pulmonary hypertension and the IntensivistPulmonary hypertension and the Intensivist
Pulmonary hypertension and the Intensivist
 
Intravenous Anaesthetics
Intravenous AnaestheticsIntravenous Anaesthetics
Intravenous Anaesthetics
 
Renal replacement therapy in intensive care
Renal replacement therapy in intensive careRenal replacement therapy in intensive care
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Predicting fluid response in the ICU
Predicting fluid response in the ICUPredicting fluid response in the ICU
Predicting fluid response in the ICU
 
ICU topics for Final FRCA
ICU topics for Final FRCAICU topics for Final FRCA
ICU topics for Final FRCA
 
Subarachnoid hemorrhage and Vasospasm
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Grand Rounds November 2009
Grand Rounds November 2009Grand Rounds November 2009
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Orientation To The Icu
Orientation To The IcuOrientation To The Icu
Orientation To The Icu
 
Fluid Resuscitation And Massive Transfusion
Fluid Resuscitation And Massive TransfusionFluid Resuscitation And Massive Transfusion
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Preoperative Assessment (Intro)
Preoperative Assessment (Intro)Preoperative Assessment (Intro)
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Icu Emergency Airway Management