Airway Lab

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July 19, 2012 by EmerJencyWEBB

Had a great airway lab today.  A few pearls I picked up today to document for later study/review…

Pediatric Airways

  • position of comfort is key in metastable airways
  • remember the key anatomic differences in peds vs. adults
  • shoulder roll for positioning
  • most use cuffed tubes for all kids these days
  • prophylactic pretreatment with atropine is not typically done anymore
  • may have to choose one tube size smaller in kids with swollen structures to prevent complications at time of extubation (i.e. subglottic stenosis)
  • Great PDF about Pediatric Emergency Airway Management.

Crichothyrotomies

  • The procedure is easy.  The decision is hard.  Once you make that decision, the rest will fall into place.
  • The finger can see better than your eyes (we did this procedure with greased up glasses on).  Be able to do this procedure blindly.
  • If you use ETT, choose 5.0 or 6.0

Jet Insufflation

  • use fast 1-2 second bursts
  • exhalation is passive for 3-5 seconds
  • if jet insufflator is not available, may take large angiocath for tracheal puncture, and add the plastic connector from a 3.0 ETT to ventilate with BVM
  • More on Jet Insufflation

Flexible Bronchoscopy

  • Practice, practice, practice
  • Remember to load ETT before you go down (poor form if you find cords, but can’t pass a tube)
  • Keep an awake airway algorithm (drugs, dosages, pre-meds, etc…) in your bag of tricks at all times.

Supraglottic Airways/Adjuncts

  • It is possible to bougie through a King Airway, and change out to ETT
  • Remember to lube the ILMA up prior to the procedure (makes a big difference)
  • Don’t get too close to glottis with glidescope, enhance your view by backing up a little to see your tube better.

Ventilators

  • Get in the habit of touching every vent you put your patient on.
  • Know the critical alarm sounds well, and respond to them like a code blue
  • Volume A/C is a great mode for the ED patient
  • However, if the pt is spontaneously breathing and intubated for non-respiratory reason, there is nothing wrong with pressure support ventilation and 40% FIO2 (not everyone needs 100% to start out)
  • For the severe asthmatic/COPD, decrease the respiratory rate, up the flow rate to 80-100, increase the expiratory time, know the pressure/volume curve for auto-peep and several treatments for this (i.e. they may do well with a PEEP of 0)

Link goes to my favorite airway checklist I’ve found and have been using for myself.

EDICT airway checklist

Credit to R. Strayer / S. Weingart / P. Andrus / R. Arntfield  Mount Sinai School of Medicine /  v13 / 7.8.2012

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