2. Airway Management The Medic One Way… By Zachary Wm. Drathman

3. Our Role in Airway Management Resuscitation: CPR, Intubation, epinephrine, shocks Trauma: Airway, breathing, circulation Medical: Airway, breathing, circulation, dysfunction

4.  Room air: Hyperventilation  Cannula: Basic exam, CP, Asthma, Minor Trauma, COPD  NRB: CHF, Inhalation, Trauma, OB, Pneumonia, Anaphylaxis, Severe COPD  BVM: CPR, Intoxicants, Seizure, Diabetic, CHF, Occlusion, Prep for ETT  OPA: Just makes “Bagging” easier Basic Airway Control

5. Equipment

6. Basic Airway Adjuncts Cannula 2-6 lpm Non-rebreather 10-15 lpm Bag Valve Mask Oropharyngal Airway (OPA)

7. The Endotracheal Tube

8. More Tubes

9. Rescue Devises King LT-D Intubating LMA Eschmann Stylet

10. Advanced Electronic Devises Glyde Scope Airtraq

11. Handle & Blades

12. Miller (Straight) Blade

13. Machintosh (Curved) Blade

14. Semi-rigid stylet

15. McGuinty Equine Oral Retractor

16. Intubation How to look like a star… And avoid the parking lot.

17. This is a quest for perfection!  Every intubation is BIG deal!  Assume each intubation will be a difficult intubation.  Give yourself every advantage.  Control your stress level.  Be “surgical”

18. Prepare your patient  Lateral alignment  False teeth  Sniffing position  Suction POSITION YOURSELF

19. What is the “Sniffing Position?”

20. An attempt to align the three planes that form the airway.

21. Three planes in the airway: Oral axis: The mouth Pharyngeal axis: Back of the throat Laryngeal axis: The trachea

22. Trying to bring the three planes as close to a parallel alignment as possible.

23. Patient Positioning Optimal position: Elevate head to align the ear to the sternal notch. Picture patients in respiratory distress: Head & neck forward, sitting upright. Have “pillowing” material available

24. I’m hanging on your every word! Recognize trouble when it arrives.

25. Technique Nurse! Wipe my forehead!

26. More than 90% of cases involving 3 or more attempts in the ED are ultimately successfully intubated using laryngoscopy. Most cases of “difficult” laryngoscopy in emergency settings are not truly difficult but instead, poorly performed at first and then subsequently managed with better technique. Do it right the first time!

27. Proper grip on the Scope

28. Proper body placement

29. MANUALLY OPEN THE MOUTH  Use the “scissor” technique. Manually opening the mouth allows control of the blade The mouth tends to be as open as it will get upon insertion of the blade. Opening it wide initially tends to provide greater success because it allows more room to pass the tube. Opening the mouth with the blade is UNACCEPTABLE!

30. FOCUS ON BLADE TIP  Treat the blade tip like a precision surgical instrument.  You are seeking the epiglotis.  Mac blade: insertion into the velecula.  Miller blade: lifting of the epiglottis. VISUALIZE ANATOMY AS YOU ADVANCE! NOT a pry bar!

31. BLADE TIP PLACEMENT Tip is in Velecula

32. BLADE TIP PLACEMENT Tip supports epiglottis

33. The Storbakken Mantra Lips Teeth Tongue Epiglottis Vocal Cords

34. 6 steps to success 1. Open mouth manually 2. Lips 3. Teeth 4. Tongue 5. Epiglottis 6. Vocal Cords Verbalize these steps RELIGIOUSLY!

35. VISUALIZE ANATOMY Tongue False Cords Epiglottis somewhere up there Gingivitis

36. VISUALIZE ANATOMY

37. TongueFalse Cords Epiglottis somewhere up there

38. VISUALIZE ANATOMY

39. LOCATE EPIGLOTTIS

40. VISUALIZATION Velecula Epiglottis Vocal Cords Tongue

41. Complete procedure Notice utilization of the Ukrainian two fisted method.