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Published byShonda George Modified over 6 years ago
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Nicole McCoin, MD Stephan Russ, MD February 22, 2007
Airway Management Nicole McCoin, MD Stephan Russ, MD February 22, 2007
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Airway Management
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Airway Management
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Airway Management
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Airway Management
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Reasons for Intubation
Airway Protection Inability to Oxygenate Inability to Ventilate Anticipated Clinical Course
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Airway Assessment Look Externally Evaluate the Rule
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Airway Assessment
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Airway Assessment Look Externally Evaluate the 3-3-2 Rule
Mallampati Classification
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Airway Assessment
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Airway Assessment Look Externally Evaluate the 3-3-2 Rule
Mallampati Classification Obstruction Neck Mobility
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Pharmacologic Agents Induction Agents Etomidate (0.3 mg/kg)
Fentanyl/Versed (0.1 – 0.3 mg/kg) Ketamine ( mg/kg) Propofol (3 mg/kg)
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Pharmacologic Agents Neuromuscular Blocking Agents Depolarizing Agents
Succinylcholine Nondepolarizing Agents Vecuronium Rocuronium
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Why RSI?
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The 6 “Ps” of RSI Preparation Preoxygenation Pretreatment
Paralysis with Induction Placement of Tube Post-intubation Management
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Preparation Opening Gambit Assess Airway Assemble Equipment
O2, O2 sat, 2 large bore IVs, cardiopulmonary monitoring Assess Airway Assemble Equipment Bag valve mask, suction, Mac/Miller blade, ET tubes / stylets, end tidal CO2 detector, nasal/oral airways, difficult airway adjuncts Prepare Intubating Medications
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Preparation Specifics
Blade type / blade size Tube size for adults and pediatrics Minimum 7.5 ETT for bronchoscopy Pediatric ETT size = (age/4) + 4
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Preoxygenation
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Pretreatment Lidocaine 1.5 mg/kg Opioids / Fentanyl 3 mcg/kg
Atropine 0.02 mg/kg Defasciculating Dose
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Paralysis with Induction
Cricoid Pressure / Sellick Maneuver Defasciculation
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Placement of Tube
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Placement of Tube Depth of tube Managing a failed intubation attempt
3x the diameter of the ETT Managing a failed intubation attempt
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Post-intubation Management
Confirmation of Tube Placement Post-intubation sedation +/- paralysis
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Post-intubation Desaturation
Displacement Obstruction Pneumothorax Equipment
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The 6 “Ps” of RSI Preparation Preoxygenation Pretreatment
Paralysis with Induction Placement of Tube Post-intubation Management
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Post-Intubation Management
The 6 “Ps” of RSI Paralysis & Induction Post-Intubation Management Pretreatment Tube Placement Preparation Preoxygenation - 10 - 8 - 6 - 4 - 2 + 2 minutes
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