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Advanced airway

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I created these slides to outline for our sales team some of the techniques and procedures that would be covered in the new Advanced Airway course. This was a challenge since I was given very little course information, so a lot of reading a research was required. In the course of creating this, I learned a lot! On this upload, deleted faculty biographies, seminar date/location, and pricing.

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Advanced airway

  1. 1. An advanced airway course designed exclusively for dentists
  2. 2. “A difficult airway is defined as the clinical situation in which a conventionally trainedanesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both.” – suggested definition from current ASA Practice Guidelines
  3. 3.  Is the office prepared to respond quickly and knowledgeably in the event of a patient experiencing airway complications or a respiratory crisis? Sedation dentists treating patients on CNS depressants need to have the ability to address airway emergencies, and standard ACLS training will not be enough. “The Advanced and Difficult Airway for Dentists” course will empower dentists with the ability to anticipate, recognize and manage a failed airway.
  4. 4. ACLS ADVANCED AIRWAY Situation: Heart stops first—  Situation: Breathing stops first— Addresses emergency situations where  Addresses emergency situations where the patient’s heart stops the patient stops breathing Seeks to prevent a “sudden death”  Seeks to prevent respiratory failure scenario caused by cardiac arrest leading to a Michael Jackson death scenario Protocols include use of AED to resuscitate  Protocols include reestablishing and maintaining an airway Example: A patient goes down, requires  Example: A patient goes down unable to AED shock, likely goes on to lead a normal breathe, if deprived of oxygen too long, productive life. can have permanent brain damage. Immediate action is critical.
  5. 5. Expert instruction Receive training from top-notch airway and emergency experts Applicable safety training Enhance skills and learn code airway techniques Hands-on practice Practice with state-of-the-art airway devices and patient simulators Advanced learning Acquire difficult airway managementalgorithms to help with challenging cases Intimidation-free educationStudy complex topics in a simple down- to-earth way
  6. 6. ADVANCED AIRWAY EXAMPLE:HANDS-ON EXPERIENCE COMMERCIAL AVIATION  Patient simulators  Captain Sully never had to face an  Pig throats for surgical airway practice engine failure until the day he made an emergency landing in the Hudson River when a “double bird strike” disabled both engines on Flight 1549.  Experience with flight simulators made this possible.  Precaution is everything.
  7. 7. For the standard, advanced & difficult airwayo Laryngoscope & direct laryngoscopy o Retrograde intubationo Endotracheal tube & tracheal intubation o Extraglottic deviceso Optically-enhanced laryngoscopy o Awake intubationo Lighted-stylet intubation o Local & topical anesthesia techniqueso Digital intubation o Methods for obese patientso Percutaneous and surgical o Pediatric airways cricothyrotomy o Alternative techniques for airway challenges
  8. 8. LARYNGOSCOPE DIRECT LARYNGOSCOPY 1. Insert laryngoscope into mouth on right side Essentially 2. Flip to left, trapping and moving tongue a viewing out of line of sight instrument Laryngoscope with Miller Blades 3. Depending on type of blade, insert either Employed to obtain either direct or anterior (Macintosh) or posterior (Miller) indirect view of vocal folds & glottis to epiglottis to facilitate tracheal intubation 4. Lift with upward and forward motion (away from operator and toward roof of mouth) 5. View of glottis is obtained, ready for tracheal intubationDirect Laryngoscopy
  9. 9. ENDOTRACHEAL TUBE TRACHEAL INTUBATION Essentially a respiratory conduit 1. Facilitated by laryngoscope to identify glottis (alternative methods also A flexible plastic or rubber tube inserted available) into trachea (windpipe) to maintain an open airway for oxygenation and 2. After trachea has been intubated, ventilation of lungs typically a balloon cuff is inflated just above the far end of the tube for the Procedure is invasive and extremely following reasons: uncomfortable, usually performed with  To secure it in place local or topical anesthesia  To prevent leakage of respiratory gases A. Endotracheal tube  To protect tracheobronchial tree from B. Cuff inflation w/ pilot balloon stomach acid and other undesirable C. Trachea material D. Esophagus 3. Secure tube to face or neck and connect to other respiratory device, ie. bag valve maskTracheal intubation
  10. 10. OPTICALLY-ENHANCED LARYNGOSCOPY EMERGENCY CRICOTHYROTOMY AKA indirect laryngoscopy  Last resort rescue technique Allows operator to see and intubate without  Percutaneous (needle) cricothyrotomy direct line of sight, ie. via monitor or viewing  Quickest and safest cric method port  Large bore intravenous catheter is used to puncture cricothyroid membraneLIGHTED-STYLET INTUBATION  Gases can then be administered through Uses illumination to facilitate placement of catheter endotracheal tube  Temporary measure to be used only until Correct placement is confirmed by anterior more definitive airway can be established glow in neck  Insufficient for CO2 ventilationDIGITAL INTUBATION Intubation without visual aid  Surgical cricothyrotomy Rarely performed since airway devices  Incision is made through skin and cricothyroid membrane in order to establish airway provide alternative Tube is guided into trachea while using index finger as a leverage point Since this technique is truly blind, correct tube placement must be rigorously confirmed Needle cricothyrotomy
  11. 11. RETROGRADE INTUBATION EXTRAGLOTTIC AIRWAY DEVICES1. Cannula is inserted through cricothyroid  Alternative to endotracheal tube membrane into trachea2. Guide wire is passed through needle  Example: King Tube upward through vocal cords into pharynx or mouth3. Wire is used to guide endotracheal tube through vocal cords4. Wire is withdrawn and endotracheal tube is advanced into trachea  For blind insertion, intended to end up in esophagus  During ventilation air passes through tube into pharynx and must enter trachea because low-pressure balloons seal pharynx and esophagus  Simplifies use: ▪ King has single lumen which prevents function if accidentally ends up in trachea ▪ Single pilot tube inflates both balloons Retrograde intubation
  12. 12. AWAKE INTUBATION METHODS FOR OBESE, ASA III PATIENTS Advantage: significantly safer because PEDIATRIC AIRWAYS spontaneous breathing and  Significant differences in airway anatomy pharyngeal/laryngeal muscle tone is and respiratory physiology maintained  Smaller airways, therefore any swelling Drawback: potential patient anxiety due to can cause critical obstruction inability to feel oneself swallow or cough, loss of gag reflex ALTERNATIVE TECHNIQUES for addressing airway anatomy challenges including:LOCAL & TOPICAL ANESTHESIA TECHNIQUES  Limited neck/jaw movement Lidocaine administered topically via spray- as-you-go technique  Deep swelling due to allergy Targeted catheter stream technique  Unusual airway anatomy Nerve blocks via strategic lidocaine  Excess fatty tissue of face or neck injections  3 major neural pathways supply sensation to airway structures
  13. 13. 16 CE credits, 2-day program or  Dr can elect to attend Day 1, Day 2, or 8 CE credits, 1-day program both  Day 1 completion is a mandatoryDAY ONE prerequisite for Day 2 Morning: standard airway techniques  Convenient for renewals Afternoon: advanced airway techniques Hands-on  Renew every 2 years Textbook situations  Advanced Airway in-office training availableDAY TWO  Team training unification Special situations and strategies  Tailored to the office Lecture, Dr. Ward Simulations On completion, attendees will receive an Airway Course Completion Card from the American Heart Association. Note: AHA advanced airway cards are not provided for team members.
  14. 14. PUT PATIENT SAFETY FIRST AND GAIN PEACE HIGHLIGHTSOF MIND  General airway evaluation  Respond quickly and knowledgeably if the patient experiences an airway-related crisis  Methods for ASA III patients such as obese or diabetic  Recognize signs of a crisis before it occurs  Pediatric airway techniques  Experience expert instruction and hands- on practice with best-in-class equipment  Supraglottic devices and training personnel  Digital intubation and other variations  Acquire a wide range of skills to employ in emergency situations  Percutaneous and surgical cricothyrotomy  Practice with some of the best patient  Video laryngoscopy simulators on the market  Aids for difficult direct largyngoscopy  Fulfill 16 AGD PACE-approved CE hours via 2-day course  Supplemental oxygen and respiration

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