Airway Management Lecture Notes

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Author:
Dthiery237
ID:
221121
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Airway Management Lecture Notes
Updated:
2013-05-28 13:53:15
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Medic 14
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  1. Factors of Airway Management
    • Airway Anatomy
    • Airway Assessment
    • Techniques of ensuring a patent airway
  2. Appropriate Airway Management
    • Open,Maintain Patent airway
    • Recognize, Treat obstructions
    • Assess Ventilation,Oxygenation Status
    • Administer Oxygen
    • Provide ventilatory assistance
  3. Goals
    • Predict a difficult airway based on clinical criteria 
    • Plan for appropriate acting in the difficult airway
    • Initiate appropriate plans of attack with confidence in the Can't ventilate/Can't intubate situations (CVCI)
  4. 6 Levels of the airway triangle
    • Basic Maneuvers
    • Basic Adjuncts
    • Intubation
    • Bail outs
    • Surgical 
    • Dead Pt
  5. 3 Intubation Reasons
    • Inability to protect and maintain patent airway
    • Failure of oxygenation or ventilation 
    • Anticipated need based on clinical course
  6. How can we identify a difficult airway?
    PTBLM
    • PMHx(Past medical history)
    • Basic Physical Exam
    • Thyromental distance
    • "Lemon Law"
    • Mallampati Class
  7. PMHx
    • Rhumatoid arthritis
    • Anklosing Spondylitis (Painful stiffening of the joint
    • Cervical Fixation devices
    • Kippel-fiel syndrome: Short wide neck, reduction in number of cervical vertebrae, and possible fusion of vertebrae
    • Thyroid or major neck surgeries
    • Pierre Robin syndrome: Small Jaw, cleft pallet,no gag reflex, downward displacement of the tongue
    • Reduced jaw mobility 
    • epiglottitis
    • tumors,known abnormal structures
    • previous problems in surgery
  8. Basic physical Exam
    • Anything that would limit movement of the neck
    • scars that indicate neck surgeries
    • kyphosis
    • burns
    • trauma,especially instability of the facial and neck structures
    • Receding chin
    • "Bull necked" 
    • "Buck teeth" beards" 
    • sunken cheeks
    • no teeth
    • extreme obesity
  9. LEMON L
    • Look externally
    • Obesity or very small
    • Short muscular neck
    • Large breasts
    • prominent upper incisors (buck teeth)
    • Receding jaw (dentures)
    • Burns
    • Facial Trauma 
    • S/S of anaphylaxis
    • Stridor
    • FBAO
  10. LEMON E
    • Evaluate 3-3-2
    • Temporal mandibular joint should allow 3 fingers between incisors 3-4cm Vertically
    • Mandible:3 fingers between mentum and hyoid bone, less then three fingers- proportionally large tongue, obstructs visualization of glottic opening-greater then 3 fingers, elongates oral axis, more difficult to align the three axis
    • Larynx adult locaed C5 C6 obstructable view of glottic opening, two fingers from floor of mouth to thyroid caritlage
  11. LEMON M
    predicts difficult laryngscopy (cormack and Lehane grading
  12. LEMON O
    • obstruction
    • blood 
    • vomitus
    • teeth
    • epiglotis
    • dentures
    • tumors
    • impaled objects
  13. LEMON N
    • Neck mobility
    • Spinal precautions
    • impaled object
    • lack of access
    • PHMx
  14. Intubation Indicator Indications
    • Hypoxia
    • hypercarbia
    • AMS
    • altered or ineffective respiratory effort
    • inability to self protect airway
    • ANTICIPATED decompensation of Pt
    • ANTICIPATED obstruction/Failure
  15. Intubation Contraindications
    • Penetrating neck trauma w/ rapidly expanding hematoma
    • tracheal injury or laryngeal fracture
    • epiglottitis 
    • Pt does not want to be tubed
  16. Methods of intubation
    • Unresponsive Oral
    • Awake Oral
    • RSI
    • Nasal
    • Digital

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