1. Difficult Airway Management Techniques

2. Facilitated Intubation Algorithm
Developed by Daniel Davis of UCSD
Designed to minimize errors during facilitated Intubation

3. Step #1: Ensuring Ventilation
Difficult airway management requires time.
The amount of time you have in the airway is determined by the patient’s oxygenation status, and their general health.

4. Step #1: Ensuring Ventilation

5. Step #1: Ensuring Ventilation
The most fundamental element of airway management is effective BVM usage.
Using the BVM to it’s full potential requires 4 essential components:
Tight Seal
Jaw Thrust
Sellick Maneuver
NPA/OPA

6. Step #1: Ensuring Ventilation
Tight Seal
OPA
Head Tilt
Sellick’s

7. Step #2: Predicting Complications
Prior to a facilitated intubation it is important to perform a pre-assessment of your patient for possible complications.
The Mnemonic (FIRST LEMON) will help to guide you in your assessment.

8. Step #2: Predicting Complications
F – Facilitated
I – Intubation
R – Requires
S – Superb
T - Techniques
L – Look
E – External
(3-3-2)
M – Mallampati
O – Obstruction
N – Neck (manual ILS)

9. Step #2: Predicting Complications

10. Step #3: Maximize 1st Attempt
In order to minimize complications, it is important to set yourself up for success on your first attempt to intubate.

11. Step #3: Maximize 1st Attempt
FlexGuide Stylet
External Laryngeal Manipulation (E.L.M)
Head Elevated Position (H.E.P)
Consider Miller Blade

12. Step #3: Maximize 1st Attempt
H.E.P
E.L.M

13. + Step #4: Assemble Team Minimum of 2 people, preferably 3 MUST HAVE
The Intubator
Person to watch the monitor
Optimally a person to assemble equipment +

14. Step #4: Intubator Tasks
Pre-oxygenate (NRB/BVM)
Pre-assessment (First-Lemon)
Determine Equipment needs
Perform Intubation
Verify Placement
Guard Tube Through Call
Should be the person with the most experience intubating.

15. Step #4: Intubator Tasks

16. Step #4: Monitor Person Tasks
Ensure Patient is on the heart monitor.
Ensure Pulse Ox is on and functioning.
Have ETCO2 ready.
Input Airway Benchmarks into LP12. (ETT Attempt, ETT Abort, ETT Succ)
Monitor for Desaturation/HR Reactivity and STOP attempt if it occurs.
Intubation Task Leader.

17. Step #4: Monitor Person Tasks

18. Step #4: Equipment Person Tasks
Set up 1st choice blade and Backup.
Set up 1st choice tube, have Backup ready.
Layout FlexGuide, be prepared to remove regular stylet.
Have rescue airway ready. (Combitube)
Have tube tie prepared.
Assist with medication prep/administration.
Serve as intubators right hand.
Can be an EMT, proper setup helps to mitigate problems.

19. Step #4: Equipment Person Tasks

20. First Attempt Unsuccessful

21. 1st Attempt Unsuccessful
Remember…..Flip a coin.
Provide immediate re-ventilation via BVM.
Next determine SaO2
SaO2 in mid-90’s
“Can’t Intubate, Can Ventilate”
SaO2 < mid-90’s
“Can’t Intubate, Can’t Ventilate”

22. Anterior Airway
FlexGuide
E.L.M.
H.E.P
Miller Blade

23. Traumatized/Obstructed Airway
Suction
Magills
Combitube
FlexGuide
Cricothyrotomy

24. Prevent Hypoxic Arrest

25. Prevent Hypoxic Arrest
SaO2 Above %
Consider another intubator,
BVM only
FlexGuide

26. Prevent Hypoxic Arrest
SaO2 Below %
Combitube
Cricothyrotomy
BVM

27. Summary Facilitated Intubation is a HIGH RISK PROCEDURE
The Goal of all airway procedures is to provide ADEQUATE VENTILATION
By improving the procedure we use to intubate, we can decrease adverse events from occuring.