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  • Difficult Airway Management: 2009 Adrian Sieberhagen

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    This document discusses the challenges of managing difficult airways in emergency departments. It notes that predicting difficulty can come from a patient's history of conditions like small mouths, tumors, or trauma. A physical exam assessing neck mobility, mouth visibility with Mallampati scoring, and distances like thyromental can also provide clues. The document recommends having an emergency airway trolley with various equipment available, like different laryngoscope blades, laryngeal mask airways, fiberoptic intubation tools, and surgical airway supplies. It describes alternative techniques that can be used if direct laryngoscopy fails, such as lighted stylets, retrograde intubation, or cricothyroidotomy. Senior staff and a structured algorithm are advised

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    Difficult airway

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    difficultairwaymanagemnt-140517035629-phpapp01

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    This document discusses the challenges of managing difficult airways in emergency departments. It notes that predicting difficulty can come from a patient's history of conditions like small mouths, tumors, or trauma. A physical exam assessing neck mobility, mouth visibility with Mallampati scoring, and distances like thyromental can also provide clues. The document recommends having an emergency airway trolley with various equipment available, like different laryngoscope blades, laryngeal mask airways, fiberoptic intubation tools, and surgical airway supplies. It describes alternative techniques that can be used if direct laryngoscopy fails, such as lighted stylets, retrograde intubation, or cricothyroidotomy. Senior staff and a structured algorithm are advised

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    © All Rights Reserved
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    26 views26 pages

    Difficult Airway Management: 2009 Adrian Sieberhagen

    Uploaded by

    dpeka dpeka
    This document discusses the challenges of managing difficult airways in emergency departments. It notes that predicting difficulty can come from a patient's history of conditions like small mouths, tumors, or trauma. A physical exam assessing neck mobility, mouth visibility with Mallampati scoring, and distances like thyromental can also provide clues. The document recommends having an emergency airway trolley with various equipment available, like different laryngoscope blades, laryngeal mask airways, fiberoptic intubation tools, and surgical airway supplies. It describes alternative techniques that can be used if direct laryngoscopy fails, such as lighted stylets, retrograde intubation, or cricothyroidotomy. Senior staff and a structured algorithm are advised

    Copyright:

    © All Rights Reserved
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    of 26

    Difficult Airway Management

    2009
    Adrian Sieberhagen
    • Clinical situation in which there is difficulty
    in Face Mask Ventilation and inability to
    intubate
    What makes it difficult in ED’s
    • Training/requirements
    • Non-controlled setting
    • Limited pre-procedural evaluation
    • Hypoxia, hypotension, agitation, dynamic
    medical conditions
    • Numerous logistical & implementation
    issues
    Predicting the Difficult Airway
    • History
    • Physical Examination
    History
    Cormack and Lehane
    • Class I: the vocal
    cords are visible
    • Class II the vocals
    cords are only partly
    visible
    • Class III only the
    epiglottis is seen
    • Class IV the epiglottis
    cannot be seen.
    • Pregnancy
    • Inflammatory Disease
    • Small mouths
    • Infections
    • Endocrine
    • Congenital
    • Trauma
    • Foreign Body
    • Tumours
    Examination
    LEMON
    • Look for external deformities
    • Evaluate 3-3-2 rule
    • Mallampati
    • Obstruction
    • Neck Mobility
    Mallampati Score
    • Class I
    – visualization of the soft palate,
    fauces, uvula, and both anterior
    and posterior pillars
    • Class II
    – visualization of the soft palate,
    fauces, and uvula
    • Class III
    – visualization of the soft palate
    and the base of the uvula
    • Class IV
    – soft palate is not visible at all
    • Thyromental Distance
    • 6.5cm normal
    • Sternomental Distance
    • >12.5cm normal
    • Protrusion of Mandible
    Management
    • Prearranged Emergency airway trolley
    available
    • Most senior staff
    Emergency Airway Trolley
    • Rigid laryngoscope blades
    • Tracheal tubes
    • Tracheal tube guides
    • Laryngeal Mask Airways
    • Fibreoptic intubation equipment
    • Non-invasive/minimally invasive airways
    • Surgical Airway
    • CO2 detectors
    Management
    • Prearranged Emergency airway trolley
    available
    • Most senior staff
    • Emergency airway algorithm
    • Deliver supplemental O2
    Alternative Airway Techniques
    • LMA/Laryngeal Tube
    • Transtracheal Jet Ventilation
    • Fibreoptic Intubation
    • Retrograde Intubation
    • Lightwand
    • Combitube
    • Surgical Airway
    Laryngeal Mask
    • Lubricated LMA inserted into hypopharynx
    • Tip in upper oesophogeal sphincter
    • Inflate Cuff
    • Muscle relaxants not necessary
    • C/I:
    – Need for high Peak Pressures
    – Risk of Aspiration
    – Pts with low lung compliance
    Laryngeal Tube
    Transtracheal Jet Insuflation
    Fibreoptic Intubation
    Retrograde Intubation
    • Place guidewire through cricothyroid
    membrane
    • Guidewire passes cephalad through
    pharynx and out mouth/nose
    • Railroad ET tube
    Lightwand
    • Flexible
    • Inserted through ET tube
    • Insert into larynx
    • Light dims if entering oesophagus
    • Limitations: Dark room
    Combitube
    • Double lumen tube
    • Placed into hypopharynx blindly
    • C/I
    – Oesophageal pathology
    Surgical Airway
    • Cricothyroidotomy
    – Complications:
    • Bleeding
    • Infection
    • Vocal cord damage
    • Tracheal stenosis
    – C/I
    • <12yrs
    • Laryngotracheal Disruption
    • Coagulopathy
    The End

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