Airway Management

GMVEMSC Education Committee

Objectives
Review

proper airway management

Review assessment
Review adjuncts and proper use

Airway Issues
BLS

intervention usually good

Ensure patent airway

Practice good BVM airway management with Oral
or Nasal Airway Adjuncts

Advanced

Airway Devices

Intubation
Rescue Airways
Confirmation Methods (Use and Documentation)

Orotracheal Intubation
Why
Securing

patent airway
Protects from aspiration
Known
Right

Issues

mainstem intubation
Unrecognized esophageal intubations
Dislodged tubes

Orotracheal Intubation
Techniques

Non Trauma
Inline Trauma

Tools

to assist

Fiberoptic scopes
Bougies
Viewmax blades
Grandview blades

Confirmation

Probably done in most cases, lacks documentation

Nasotracheal Intubation
Why
Spontaneously
Clenched

Known
Use

breathing patient

jaw

Issues

of too small an E.T. Tube

Hypopharyngeal placement
Trauma to airway

Confirmation Methods

Daves Five

End Tidal CO2 OR EDD

Detection
Waveform / Numerical Capnography

Visualization
Auscultation
Measurement at the teeth (or gum line in peds)
Chest Rise / Fall
Fogging of the tube
Skin color and change
Pulse Oximetry

Use Multiple Methods (at least five)

Confirmation Methods
Other

Apply Cervical Collar following intubation to

maintain head / neck position
Secure with commercial device or other methods

Document

Include all methods used in your narrative

Also document the results

This should include at least five items

Especially capnography and / or colorimetric color change

Recheck of tube placement post movement

Rescue Airways
When
As

are they appropriate

a Primary Airway;

Due

to suspected difficult airway capture based

on assessment and anatomical features
Pediatric patients as preferred by Childrens
As

a Rescue Airway;

After

failed attempts at intubation

After failed attempt at intubation during the
Sedate to Intubate procedure.

Types of Rescue Devices

LMA
Combitube
PTL
King

Laryngeal Mask Airway

http://www.lmana.com/unique.php

Laryngeal Mask Airway

Why

As an alternative to the face mask for achieving and

maintaining control of the airway.
LMA airways are indicated for use in:

Known or unexpected difficult airways

Establishing an airway during resuscitation in the profoundly
unconscious patient with absent gag reflex

Known Issues

Multiple sizes, based on weight, match correct syringe with

device to inflate cuff
Does not prevent aspiration
Improper placement (cuff folded over)
EDD is not recommended as a confirmation device with the
LMA
Is NOT a medication route for Endotracheal drugs

Combitube

http://www.combitube.org/

Combitube

Why

Unconscious / unresponsive patients without gag reflex

Blind insertion technique
Alternative to E.T.T.

Known Issues

Two sizes, limited to patients over 4 foot.

Obtaining proper seal / placement
Ventilating through correct tube
Is NOT a medication route for Endotracheal drugs unless placed in
the trachea (i.e. ventilating tube 2) (consult mfg recommendations)
Contraindications

Patients with intact gag reflexes

Patient's height below 4 feet
Patients with known esophageal pathology
Patients after ingestion of caustic substances
Central-airway obstruction

PTL

Gettig Pharmaceutical Instrument Company

http://216.92.52.175/ptl.html

PTL

Why

Unconscious / unresponsive patients without gag reflex

Blind insertion technique
Alternative to E.T.T.

Known Issues

Obtaining proper seal / placement

Ventilating through correct tube
Is NOT a medication route for Endotracheal drugs unless it is placed
in the trachea (consult manufacturer recommendations)
CONTRAINDICATIONS:

Children - under the age of 14

Conscious or semiconscious patients
Known caustic poisoning cases
Known esophageal disease

King Airway

http://www.kingsystems.com/

King Airway

Why

Unconscious / unresponsive patients without gag reflex

Blind insertion technique
Alternative to E.T.T.

Known Issues

Obtaining proper seal / placement

Is NOT a medication route for Endotracheal drugs
Multiple sizes, based on height, also multiple cuff volumes
Contraindications

Responsive patients with an intact gag reflex.

Patients with known esophageal disease.
Patients who have ingested caustic substances.

Conclusion
Many

devices available to providers

Be familiar with what you have available to
your organization.
Immobilize to maintain head / neck position.
Recheck lung sounds and End Tidal CO2
frequently
Document device use and at least five
confirmation methods used with results.

 Questions

/ Discussion