Seldinger Cricothyrotomy Review

1
SeldingerCricothyrotomyReview

• 2005 ACP Recert
• (Enhansed)

2
What is an Indication for Intubation?

• ? LOC
• Obtain / Maintain / Protect Airway
• Oxygenation
• Positive Pressure Ventilation or control
  ventilation
• Drugs (NAVEL)
• ? Fatigue
• Access Tracheal Toilet (suction)

3
Next Determination ?

• Once the decision to intubate has been made a
  then what?
• Is it a CRASH intubation?
• Death or near death (like NIKE just do it)
• Suction, stylette, lubed ETT, stethoscope,
  laryngoscope
• If time permits assess for DIFFICULT intubation
  using?
• LEMON

4
CRASH AIRWAY

• VSA
• Pending VSA
• Respiratory Arrest
• GCS lt 5
• Airway compromise (blood / vomit unable to clear)
• Note positioning is the number 1 airway
  procedure to prevent aspiration.

5
Difficult Airway Assessment

• L - Look 1 point
• E - Evaluate 2 points
• M - Mallampati (1 - 4) 2 points
• O - Obstruction 2 points
• N - Neck 1 point 2 or more equals
  difficult

If a difficult airway has been assessed be
cautious about sedation
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LEMON

• L - Look (visual assessment) 1 point (each)
• Under / over bite
• Big teeth
• Facial hair
• No neck
• Barrel chest
• Gut feeling tough tube!!!

7
LEMON

• E - Evaluate 2 points
• Ability to open mouth 3 fingers
• Anterior Larynx 3 fingers
• Superior Larynx 2 fingers
• Children and Asians have anterior and superior
  larynx.

8
LEMON

• M - Mallampati (1 - 4) 0 or 2 points
• 1 can see all of uvula
• 2 can see most of uvula
• 3 can see a part of uvula
• 4 can see none of uvula - all hard palate
• Paramedics should lean to a 1 or 4 interpretation.

9
LEMON

• O - Obstruction 2 points
• Tumors
• Hematoma
• Swelling

10
LEMON

• N - Neck 1 point
• Immobility, unable for flex or extend neck
• C -spine precautions
• Kyphosis
• Osteoporosis
• Severe Rheumatoid Arthritis
• 2 or more equals difficult airway is expected

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What if it is difficult?

• Concern for paralytics and heavy use of
  analgesics and sedatives. If patient quits
  breathing and you are unable to ventilate - you
  have broken fundamental premise of medicine
  CAUSE NO HARM.
• Before taking TOTAL control of a patients airway
  an accurate / defendable assessment for due
  diligence AND a back up must be available.
• Blind nasal intubation with slight sedation may
  be beneficial.