Airway Management Anesthesia View

Slides:

Advertisements

Similar presentations

Bougie ET introducer.

Advertisements

MANAGEMENT OF TRAUMA VICTIMS MAN MOHAN HARJAI Associate Professor Army Hospital (Research and Referral) Delhi Cantt INDIA.

Rural Trauma Team Development Course© (RTTDC)

Out of OR Airway Management Program Hines VA Medical Center

Newborn care and resuscitation June 24, 2014 Michael Kim, MD Newborn care and resuscitation 2014 Emergency Care Trauma Symposium June 24, 2014 Michael.

Difficult Airway Management for Trauma: New Laryngoscope EVO2 Takami Komatsu and Yutaka Iwama Critical Care Center Teikyo University Hospital Tokyo, Japan.

DAS Guidelines update April 2015

Failed Intubation in Children Dr Philip Ragg Royal Children’s Hospital Melbourne.

Context Sensitive Airway Management Orlando Hung Departments of Anesthesia and Surgery, Dalhousie University, Halifax, Nova Scotia.

1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license.

Emergency Department Thoracotomy: A Hybrid Simulation With A Clinical Outcome.

Emergency Intubation An instructional program for Licensed Respiratory Practitioners at Kaleida Health.

Harsharon Chopra, BS 1, Josh Malo, MD, John Sakles, MD 2, Cameron Hypes, MD, MPH 2,3, John W Bloom, MD 2, Jarrod Mosier MD 2,3 1 The University of Arizona.

New Orleans EMS Airway Lecture Series: Lecture 2 Oxygenation and Bag-Mask Ventilation Jeffrey M. Elder, M.D. Deputy Medical Director.

Awake Fiberoptic Intubation Outside the Operating Room: Lidocaine “Rinse and Swish” Technique Awake Fiberoptic Intubation Outside the Operating Room: Lidocaine.

1 Code Team Members Roles and Responsibilities Jamileh Mokhtari nori, MSN, PhD candidate Nursing Faculty, Nursing Management Dept., Baqiyatallah Medical.

Pediatric Prehospital Airway Management By: Aaron Mills 11/26/07.

Quality Control In Critical Care Training By Zyllan Spilsbury (F2)

Feasibility of a combined use of a video-laryngoscope with a novel flexible video-stylet for predicted difficult intubation Rainer Lenhardt, MD, MBA, Rachana.

Optional, AEMT. Course Objectives Describe Sellick’s maneuver and the use of cricoid pressure during intubation. Describe the necessary equipment needed.

Intubation Assist Respiratory Services Oct

#6 Essential Emergency Airway Care-Video Laryngoscopy

Clinical Evaluation of the Storz CMAC Video Laryngoscope in the Known or Predicted Difficult Airway Michael Aziz, MD. Dawn Dillman, MD. Ansgar Brambrink,

Airway 101 UCSF-Fresno June 19, 2015.

Abdullah Alsakka E.M. Consultant. Questions For The Emergency Physician: 1. Can I predict the difficult airway? 2. How often can I expect to be faced.

Airway Management of Patients with a Difficult Airway Orlando Hung Departments of Anesthesia and Surgery, Dalhousie University, Halifax, Nova Scotia Canada.

LEVEL OF PREHOSPITAL CARE providers. EMS 484 LECTURE.5 Dr. Maha khalidDr. Maha khalid.

Research In Airway Management Medic One Tuesday Series April 2009 Keir J. Warner, BS Paramedic Training.

Anthony Charles Caputo, DDS, FACD, FICD, DADBA, DNDBA Anthony Charles Caputo 25 th Annual Meeting on Special Care Dentistry Dentistry and Anesthesia in.

Five New Devices for the Difficult Airway

THE DIFFICULT AIRWAY P. Andrews F08. Stages Of Respiratory Compromise n Respiratory Distress n Respiratory Failure n Respiratory Arrest.

Simulation and its Future in Education Shahzad Waheed, MD, FAAP, FRCP(C)

Rapid Sequence Induction

Do You See Anything That You Recognize: Teaching Novice Student Registered Nurse Anesthetists to Intubate Using the GlideScope Stephanie K. McHenry, CRNA,

Assessing the Difficult Airway in the ED

Airway Management Techniques By Hwan Joo MD. Airway Presentation  Normal Airway Management  Closed Claims  Difficult Intubation and Tools  Difficult.

End of Shift Milestone Evaluation Forms

Difficult Airway. Definition The clinical situation in which a conventionally trained anesthesiologist experiences difficulty with mask ventilation, difficulty.

Basic Life Support (BLS) Advanced Life Support (ALS) Dr. Yasser Mostafa Prof. of Chest Diseases Ain Shams University.

Preparing for the Critical Airway-not just the Difficult Airway-in the PICU Jeffrey Burns, M.D., M.P.H. Chief, Division of Critical Care Medicine Children’s.

Intro to:. Objectives  Define RSI  Identify the Indicators for using RSI  Identify the relative contraindications and disadvantages of RSI  Discuss.

Can you see the cords?. RSI in ED Core competency Direct laryngoscopy has long been the main stay management of the airway Advances in technology brings.

Q4.10 – October 2010Airway Management Essentials© Copyright 2010 American Safety and Health Institute Airway Management Essentials.

Emergency Department Of Rasool-Akram Hospital. Airway Management P. Hafezi MD Emergency Medicine.

Lesson 10 Summation Putting It All Together. Key Points (1 of 4) Safety of providers and patients –Number one priority Prearrival preparedness and scene.

Chapter 17 Emergency Procedures. Copyright © 2007 Thomson Delmar Learning. ALL RIGHTS RESERVED.2 Protecting the Airway Airway –Structure through which.

Indicate on this diagram any sutures in place This patient has a New TRACHEOSTOMY UPPER AIRWAY ABNORMALITY: Yes / No Document laryngoscopy grade and notes.

Emergency Airway Algorithm

Anesthesiologist By Masa Kim. Basic tasks Basic tasks Monitor patient before, during, after anesthesia Gives intravenous fluids to patient to control.

Emergency Cricothyrotomy: Comparing Four Methods Summary and Comment by Aaron E. Bair, MD, MSc, FAAEM, FACEP Published in Journal Watch Emergency Medicine.

Airway Doctor Two minute training Airway Doctor Airway manoeuvres and adjuncts Nasal prongs 15L/min Bag Valve Mask (Ambu Bag) + 15L/min +/- ventilate 2-person.

Indicate on this diagram any sutures in place This patient has a New TRACHEOSTOMY UPPER AIRWAY ABNORMALITY: Yes / No Document laryngoscopy grade and notes.

Airway Training WGH Simulation afternoon WGH 22/01/2016 Thomas Bloomfield ST4 Anaesthetics.

Insert Program or Hospital Logo Introduction ► Due to changes in delivery room practices, improvement in clinical care, and limitations on the time spent.

Airway. Learning Objectives At the end of this session you will be able to Describe the main aims of airway management in trauma Predict specific difficulties.

Endotracheal Intubation – Rapid Sequence Intubation

The Emergency Department Professor Jonathan Benger College of Emergency Medicine 30/03/20111.

So you want to Dominate the Difficult Airway? By Kane Guthrie Clinical Nurse SCGH ED.

The 61th Ontario Medical Association Anesthesia Meeting

ALFRED ICU INTUBATION CHECKLIST

Narjes Hajer Naouar Anesthesia Technologist

Airway Basics Matt Hallman, MD.

Presented by Katie Dillon, BSN, RN, CPN & Kelsi Kliment, BSN, RN, CPN

[Exercise Name] [Date]

Anesthes. 2009;110(1): doi: /ALN.0b013e318190b6a7 Figure Legend:

Background and Objectives

177 Comparison of Endotracheal Intubation With Macintosh or Miller Laryngoscope by Inexperienced Operators in Simulated Difficult Airway Model J. Seo,

Equibments of intubation

Airway management If you do not manage the patient’s airway – they will die Simple MANOEUVRES save lives © BASICS Education March 2019.

Presentation transcript:

Airway Management Anesthesia View Andreas Grabinsky, MD Assistant Professor, Dept. of Anesthesiology Program Director and Section Head, Emergency & Trauma Anesthesia Harborview Medical Center

Overview Airway management in the field Airway management in the hospital Indications Priorities Problems

OR Airway Management

Field Airway Management

In the OR

OR Setting 26 Operating rooms > 1.000 cases per month 13 Anesthesiology Attendings 26 Residents / CRNA’s Start 07:30AM (Wednesday 08:30AM) 26 potential airways at 07:30AM

The OR Whiteboard

What to do ? Find the Anesthesiologist in charge Find the anesthesiologist (covers 2-3 rooms) Help out Hope you “get the airway” Stay in one of the rooms (first rotation) Find a “late start room” for another airway (second rotation)

Learning Goals Identify difficult airway Proficient bag/mask ventilation Use of alternative airway techniques Prepare Intubation Learn about RSI Demonstrate Laryngoscopy / Intubation

The Intubator

Airway Priorities 1. Oxygenate 2. Ventilate 3. Protect Airway

Use the least aggressive means necessary for airway management Spontaneous ventilation Assisted mask/bag ventilation Controlled mask/bag ventilation Intubation + controlled ventilation Surgical airway + controlled ventilation Use the least aggressive means necessary for airway management

Indications for Intubation Insufficient Oxygenation Insufficient Ventilation Loss of airway protection Impending airway problems (CNS, Trauma)

Preparation Oxygen Ambu bag with mask Suction Laryngoscope (working) different size ETT Plan B (Adjuncts)

Prevention of Failure Assess situation Decision for specific airway management Communicate Plan B Reassess (change plan, if needed)

Failure to intubate in the OR Use alternative methods Get help Wake patient up

Failure to intubate in the Field Use alternative methods Failure is not an option !

Do not mess with a perfectly fine airway. Prevention of Failure Do not mess with a perfectly fine airway.

Publications

Airway Assessment

Difficult Airway

Harborview Specials

Indications for Intubation Insufficient Ventilation Insufficient Oxygenation Loss of airway protection Impending airway problems (CNS, Trauma)

Training

Preparation Oxygen Ambu bag with mask Suction Laryngoscope (working) different size ETT Plan B

Tools

Real Men use Miller Blades

i-gel

Res-Q-Scope

Glidescope

Glidescope

Glidescope 25 Paramedic students Glidescope versus Macintosh 3 blade 100 intubations in different scenarios on manekin Significant better visualized glotic opening with Glidescope Same success rate of 76% Increased time to intubation with Glidscope Aziz, Michael, Dillman, Dawn, Kirsch, Jeffrey R. and Brambrink, Ansgar(2009)'Video Laryngoscopy with the Macintosh Video Laryngoscope in Simulated Prehospital Scenarios by Paramedic Students',Prehospital Emergency Care,13:2,251 — 255

Res-Q-Scope 22 US military parmedic (50 manekin and 8 human intubations) 22 Emergency medicine residents/attending 20 minutes instruction and 20 minutes training, 3 trials with each device Intubation time Res-Q-Scope 25.9 seconds Intubation time direct Laryngoscopy 14.6 seconds Shawn M. Varney MD⁎, Melissa Dooley MD, Vikhyat S. Bebarta MD Faster intubation with direct laryngoscopy vs handheld videoscope in uncomplicated manikin airways American Journal of Emergency Medicine (2009) 27, 259–261

Questions ?