Acute Airway Management

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Acute Airway Management

• M. Shakir Ejaz

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Objectives

• To summarize some of the commonly used acute
  airway management strategies.
• Noinvasive and invasive methods will be
  mentioned.

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Initial Approach

• ABC
• (ample)
• Monitors
• Secure IV access.
• Pt positioning.

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Evaluation of the upper airway

• AOJ angle
• Mallampatti classification
• Thyromental distance

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Intubation checklist

• Ensure ABCs
• Access airway
• Prepare equipment
• Proper positioning
• RSI if needed
• Cricoid pressure
• Scope inserted
• Tube inserted
• Confirm placement
• Inflate bulb
• Release cricoid pressure
• Secure tube

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Orotracheal Intubation

• Size tube / blade
• Equipment
• Confirmation ( ET CO2, EDD )
• Hyperventilate
• Insert stylet
• Lubricate the ETT tip
• /- Neb lidocaine
• Blade choice straight v/s curved
• Sellicks maneuver ( vomitting? )
• Horizontal axis
• BURP
• 22 cm
• Attach, listen. Inflate. ET CO2.
• Backup abort and BVM
• Secure

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RSI

• Sedate
• (ketamine, thiopental, etomidate, fentanyl,
  propofol, midazolam, opoids)
• Paralyze
• (Succinyle choline 1.5 mg/kg IVP. Works in 30-60
  sec lasts 4-8 min. also 200 mg IM can be used)
• Prefer vec. for increased ICP/ head trauma.

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Others

• Nasotracheal intubation (?minimize cervical
  movement)
• Combitube
• LMA
• Digital intubation
• Retrograde Tracheal Intubation
• Lighted stylet
• Fiberoptic Intubation
• Cricothyrotomy

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