Airway Management Algorithms
Advanced Airway Management: The Need to Know Information
WFA Clinical Education Team
Airway Management Algorithms Airway 911 Multiple Attempts Intubation Flow Chart (Adapted)
Optimal First Intubation Attempt • • • • •
Sniffing/ramped position(if no C spine injury) Straight to cuff stylet <35◦ Jaw thrust (by assistant) Reduce cricoid force (by assistant) External laryngeal manipulation
Missed First Intubation Attempt (Acknowledge Difficult Airway) • • • •
Get help Bougie Change head position Change device
BVMV if Hypoxic
Missed Second Intubation Attempt • • • •
Change blade Change person Change device Reduce C-spine precautions
(Acknowledge Missed Airway)
BVMV if Hypoxic Missed Third Intubation Attempt (Acknowledge Missed Airway)
Extraglottic Airway (EAD)
EAD Failure Surgical Airway
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If Unable to Maintain Saturations with Optimal BVMV
Airway Management Algorithms
The Spectrum of Airway Management
Position of comfort Awake Supplemental oxygen NIPPV Bag- valve-mask “assisted “ respirations Nasopharyngeal airway Oropharyngeal airway Bag-mask-valve ventilation Extraglottic airway Endotracheal intubation Surgical airway Nearly Dead
WFA Clinical Education Team
Airway Management Algorithms
Airway Definitions
Difficult Airway 1. Predicted to be difficult (LEMONS, RODS) OR 2. Proves to be difficult (more than ONE attempt required)
Missed Airway 1. The provider is unable to intubate within three attempts OR 2. Critical oxygenation cannot be maintained at any time
Crash Airway 1. Patient is “dead” (cardiac arrest or respiratory arrest) OR 2. Patient is “nearly dead” (agonal respirations)
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Airway Management Algorithms
Difficult Bag Mask Ventilation
MOANS M = Mask seal O = Obesity/Obstruction A = Age N = No teeth S = Stiff/Snoring
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Airway Management Algorithms
Optimal Bag Valve Mask Ventilations (BVMV) 2 People
One to ventilate, One to hold the Mask
2 Airways
NPA +OPA
2 Fingers
For cricoid pressure
2 Inches
Head elevation to sniffing Position
2 Seconds
Slow ventilations
2 PSI
Minimum pressure for chest rise
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Airway Management Algorithms
Difficult Extraglottic Device
RODS R = Restricted mouth opening O= Obstruction D= Disrupted or distorted airway S= Stiff lungs or cervical spine
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Airway Management Algorithms
WFA Clinical Education Team
Airway Management Algorithms
WFA Clinical Education Team
Airway Management Algorithms
Difficult Intubation
LEMONS L = Look externally E = Evaluate 3-2-3 rule M =Mallampati score O = Obstruction N = Neck mobility S = Saturations
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Mallampati ViewsAirway Management Algorithms
I
III
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II
IV
Airway Management Algorithms
3-2-3 Rule
Three fingers for the mouth opening
Two fingers from hyoid bone to thyroid cartilage
Three fingers from tip of chin to hyoid bone
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Airway Management Algorithms
Preparation
SOAP ME S
= Suction
O = Oxygen A
= Airway equipment OPAs and NPAs Bag valve mask ET tubes and stylet Laryngoscope handle and blades Magill forceps Rescue airway devices
P
= Pharmacology
ME = Monitoring equipment ECG and defibrillator Pulse oximeter EtCO2 monitor
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Airway Management Algorithms
Cormack and Lehane Airway Grading Scale
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Airway Management Algorithms
Difficult Cricothyrotomy
SHORT S = Surgery or other airway disruption H = Hematoma (includes infection/ Abscess) O = Obesity R = Radiation distortion T = Tumour
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