iso ana Emergency shal examination A Cannot ventilate ‘ava car away? Yes No ‘peor ures Proper Cannot intubate | [1 DL/VL attempt PA posi? posnnng Cannot ventilate | | (without relaxation) J ——— | Yes Rea nol Yes J Call for help STAT Tracheal PA sevessi [ncuron of GA (Anesthesiologist andior surgeon) intubation ‘Conan "°C Bu doauate? Sat ‘Yes Fixed obstruction ‘Awaxe basen at or below cords?, “oid vio one Yes maleon induc ¥ ‘Awaken Patient Coninue neste Yes No No ¥ ¥ ¥ ‘Awake Intubation ‘SGAor intubation stylet LMA, technique T Yes, ETT] Yes, SGA or LMA, ICS Figure 10-8 Pathway A: cannot ventiate, cannot intubate. DL Direct laryngoscopy; ETT. encotrachea! tube: ILMA, intubating laryngeal mask ainway; SGA, supragiottic ciway; VL video laryngoscopy.No Emergency Patient Anosthotized, Oxygenation and Ventilation Adequate via SGA Call for assistance (Anesthesiologist and/or surgeon) Reattempt laryngoscopy (change blade lengttypo, [e.9, VL] Grade 4 Yos No FO}, special laryngoscope blades, or retrograde" 1 ‘Sucoesstul? LP ‘SGA oriLMA se Continue anesthesia ‘Awaken patient Aurake intubation or postpone surgery Flin combo with SGA}-——>| Continue anesthesia Figure 10-10 Pathway C: ventilation established through a subglct tig away, futher management options. FOI. Floeroptic intubation SGA, supragiotic airway. All Attempts to Oxygenate Unsuccessful, Mask Ventilation Impossible D Surgical airway ere >| Surgical Patient: Child <6 yrs? Sear Yes y c] . * May proceed directly to SGA, if desired Figure 10-9 Pathway & con ventite. but cannot infubste vie leryngoscopy. Fl Fiberopiic intubation: ILMA. intubating laryngeal ‘mask Gitway: SGA suprogiottic aiwoy; VL video laryngoscopy. ‘Transtracheal jet ventilation or surgical tracheostomy" * Obtain surgeon's assistance, but without unnecessary delay, if possible Figure 10-11 Pathway D: surgical airway management,