airway management with the vortex approach, presented @ www.developingem.com 2014 at Salvador de Bahia, Brazil

1. Verschiedene Airway- Algorithmen
http://www.vortexapproach.com/Vortex_Approach/Vortex.html

2. Mendelsons- Syndrom (1946)
Mortality former times up to 60%, now ~ 3%
Mortality servere ARDS in prone position 23,6%
Aspiration (RSI in ED) 0,8-5,9%
DeSat (RSI in ED) 9,2-37,8%
Priority on alveolar
oxygenation
NO DESAT

4. Don't fail to
Plan for
Failure
Cook TM et al. NAP4. BJA 106 (5): 632–42 (2011)
.

6. Vortex

8. etCO2: Capnography
metabolism - cardiac output - perfusion - ventilation

9. .
http://www.vortexapproach.com/Vortex_Approach/Vortex.html

10. .

11. Naso-pharyngeal
Extraglottic
airway- devices
Oro-
pharyngeal

12. BLS
Gerstein NS et al. Efficacy of facemask ventilation techniques in novice providers. J Clin. Anesth 2013 May;25(3):193-7

13. mask
thermo- elastomeric material
(self-adapting)
vent reduces risk of aspiration
iGEL-

14. Laryngeal tube
2 cuffs
with one
blow

15. Cricoid- pressure no more imperativley recommended
Complications follow First-attempt Failure
Some Training for ETI required
Checklists support procedure
Trained Teams Succeed
Transglottic
Endotracheal Intubation

16. .
.
...no clear recommendations...
Airway-
competent
societies
…

17. .
Emergenc
y surgical
airway

18. .
Cric-Kit
(1959)
Peter Safar

19. Plan for Failure
5 Airways
Progress in Process
NODESAT

20. references
*American Society of Anesthesiologists: Practice guidelines for management of the difficult airway: Anesthesiology 2003; 98:1269–1277. update:
Anesthesiology 2013; 118:251–70
J. J. Henderson et al. Difficult Airway Society guidelines for management of the unanticipated difficult intubation http://www.das.uk.com
A. Timmermann et al. Handlungsempfehlung für das präklinische Atemwegsmanagement* Anästh Intensivmed 2012;53:294-308
T. M. Cook 1 et al. On behalf of the Fourth National Audit Project. British Journal of Anaesthesia 106 (5): 632–42 (2011)
Christopher T. et al. The Success of Emergency Endotracheal Intubation in Trauma Patients: A 10-Year Experience at a Major Adult Trauma
Referral Center. Anesth Analg 2009;109:866–72
Chesters A. et al. Prehospital anaesthesia performed in a rural and suburban air ambulance service staffed by a physician and paramedic: a 16-
month review of practice. Emerg Med J. 2014 Jan;31(1):65-8.
Ellis DY et al. Cricoid pressure in emergency department rapid sequence tracheal intubations. Ann Emerg Med 2007;50:653-65
Bernhard M et al. Developing the skill of endotracheal intubation: implication for emergency medicine. Acta AnaeScand 2012;56:164-171
Alexander F. Arriaga et al. Simulation-Based Trial of Surgical-Crisis Checklists NEJM 2013; 368:246-253
http://www.intersurgical.com/ http://daveairways.wordpress.com/
http://www.vortexapproach.com/Vortex_Approach/Vortex.html
Müller JU et al. The use of the laryngeal tube disposable by paramedics during out-of-hospital cardiac arrest: a prospectively observational
study Emerg Med J. 2013 Dec;30(12):1012-6.
Schalk R. et al. Disposable laryngeal tube suction: standard insertion technique versus two modified insertion techniques for patients with a
simulated difficult airway. Resuscitation. 2011 Feb;82(2):199-202
V. Dengler et al. Präklinische Anwendung des Larynxtubus Der Anaesthesist February 2011, Volume 60, Issue 2, pp 135-138
John C. Sakles et al. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Academic
Emergency Medicine Volume 20, Issue 1, pages 71–78, January 2013
Guérin et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome (PROSEVA). New Engl J Med 2013;epublished May 20th