Intermediate aw devices

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  • 1. INTERMEDIATE AIRWAY DEVICES Paleerat Jariyakanjana, MD Emergency PhysicianLOGO Naresuan University 12 Sep 2012
  • 3. Indicationsrescue device for pediatric & adult emergency airway Mxpt c brisk bleeding above the glottis or with difficult face mask ventilation owing to a beard, severe facial trauma, or obesity
  • 4. Contraindicationsrelatively  awake pt, especially those c a full stomach  Decreased mouth opening  severely distorted upper airway anatomy
  • 5. Placement of the LMAselect the appropriate-sized LMA  size 1 for neonates <5 kg – size 5 for adults > 100 kg
  • 6. Placement of the LMAcompletely deflate the LMA cuff while pushing it posteriorly, so that it forms a smooth wedge shape without any wrinkles
  • 7. Placement of the LMAPlace a small amount of water- based lubricant onto the posterior surface of the LMA maskbest position: sniffing position
  • 8. Placement of the LMA2 different techniques 1. most common method: index finger insertion technique 2. alternative method: thumb insertion technique
  • 9. Index finger insertion techniqueholding the LMA like a pen, c the index finger at the junction of the airway tube & the cuff
  • 10. Index finger insertion techniqueuse the index finger to slide the LMA along the hard palate
  • 11. Index finger insertion techniqueContinue to push the LMA into the hypopharynx until resistance is felt.
  • 12. Index finger insertion techniqueUse the other hand to hold the proximal end of the LMA airway tube while removing your index finger
  • 13. Placement of the LMAAfter the LMA is fully inserted, inflate the cuff½ maximum cuff volumeConfirm: chest rise, breath sounds, and capnography
  • 14. Placement of the LMA
  • 15. Complicationsaspiration of gastric contents & hypoxia
  • 17. 2 parallel lumens  small distal cuff, large proximal cuffBlindly  esophagus 90%, trachea 10%
  • 18. Indicationsprimary airway in patients who are unresponsive or in cardiac arrestrescue ventilation after failed bag- mask ventilation or failed intubation
  • 19. Contraindicationsintact gag reflex<4 feet tallsuspected caustic poisonings or proximal esophageal disorders
  • 21. isolate the glottis opening between an oropharyngeal cuff and an esophageal cuff
  • 22. Like the Combitube, the King LT is designed for blind placement and has a large proximal cuff and small distal cuff.Unlike the Combitube, the tip of the King LT is designed to be placed into the esophagus only.The shape of the King LT and the size of the tip make it unlikely to be placed into the trachea.
  • 23. Indications~CombitubeContraindicationsrelatively: foreign body upper airway obstruction
  • 24. Placement of the King LT1st step: choose the proper size King LT  available only in adolescent and adult sizes  size 3: yellow, 4-5 feet in height  size 4: red, 5-6 feet in height  size 5 designed for patients >6 feet in height.Check the cuffs and then completely deflate them prior to placementLubricate the device with a water- based lubricant.best patient position: sniffing position
  • 25. Placement of the King LTHold the LT at the connector with the dominant hand and hold the mouth open by grasping the chin with the nondominant hand.Introduce the tip of the device into the corner of the mouth while rotating the tube 45°-90° so that the blue orientation line on the tube is touching the corner of the mouth.Pass the tip of the device into the mouth and under the tongue.
  • 26. Placement of the King LTAs the tip passes under the base of the tongue, rotate the tube back to the midline so that the blue orientation line faces the ceiling.advance the King LT until the connector is aligned with the teethInflate the cuffs with the minimum volume necessary to create a good seal.Ventilate with a bag-valve system and confirm placement with chest rise, breath sounds, and capnography.
  • 27. Complicationsnot extensively documentedmost serious potential complication: tracheal placementImproper placement
  • 28. ReferenceClinical procedures in emergency medicine, 5th edition