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Airway Management Algorithms

Advanced Airway Management: The Need to Know Information

WFA Clinical Education Team


Airway Management Algorithms Airway 911 Multiple Attempts Intubation Flow Chart (Adapted)

Optimal First Intubation Attempt • • • • •

Sniffing/ramped position(if no C spine injury) Straight to cuff stylet <35◦ Jaw thrust (by assistant) Reduce cricoid force (by assistant) External laryngeal manipulation

Missed First Intubation Attempt (Acknowledge Difficult Airway) • • • •

Get help Bougie Change head position Change device

BVMV if Hypoxic

Missed Second Intubation Attempt • • • •

Change blade Change person Change device Reduce C-spine precautions

(Acknowledge Missed Airway)

BVMV if Hypoxic Missed Third Intubation Attempt (Acknowledge Missed Airway)

Extraglottic Airway (EAD)

EAD Failure Surgical Airway

WFA Clinical Education Team

If Unable to Maintain Saturations with Optimal BVMV


Airway Management Algorithms

The Spectrum of Airway Management

Position of comfort Awake Supplemental oxygen NIPPV Bag- valve-mask “assisted “ respirations Nasopharyngeal airway Oropharyngeal airway Bag-mask-valve ventilation Extraglottic airway Endotracheal intubation Surgical airway Nearly Dead

WFA Clinical Education Team


Airway Management Algorithms

Airway Definitions

Difficult Airway 1. Predicted to be difficult (LEMONS, RODS) OR 2. Proves to be difficult (more than ONE attempt required)

Missed Airway 1. The provider is unable to intubate within three attempts OR 2. Critical oxygenation cannot be maintained at any time

Crash Airway 1. Patient is “dead” (cardiac arrest or respiratory arrest) OR 2. Patient is “nearly dead” (agonal respirations)

WFA Clinical Education Team


Airway Management Algorithms

Difficult Bag Mask Ventilation

MOANS M = Mask seal O = Obesity/Obstruction A = Age N = No teeth S = Stiff/Snoring

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Airway Management Algorithms

Optimal Bag Valve Mask Ventilations (BVMV) 2 People

One to ventilate, One to hold the Mask

2 Airways

NPA +OPA

2 Fingers

For cricoid pressure

2 Inches

Head elevation to sniffing Position

2 Seconds

Slow ventilations

2 PSI

Minimum pressure for chest rise

WFA Clinical Education Team


Airway Management Algorithms

Difficult Extraglottic Device

RODS R = Restricted mouth opening O= Obstruction D= Disrupted or distorted airway S= Stiff lungs or cervical spine

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Airway Management Algorithms

WFA Clinical Education Team


Airway Management Algorithms

WFA Clinical Education Team


Airway Management Algorithms

Difficult Intubation

LEMONS L = Look externally E = Evaluate 3-2-3 rule M =Mallampati score O = Obstruction N = Neck mobility S = Saturations

WFA Clinical Education Team


Mallampati ViewsAirway Management Algorithms

I

III

WFA Clinical Education Team

II

IV


Airway Management Algorithms

3-2-3 Rule

Three fingers for the mouth opening

Two fingers from hyoid bone to thyroid cartilage

Three fingers from tip of chin to hyoid bone

WFA Clinical Education Team


Airway Management Algorithms

Preparation

SOAP ME S

= Suction

O = Oxygen A

= Airway equipment OPAs and NPAs Bag valve mask ET tubes and stylet Laryngoscope handle and blades Magill forceps Rescue airway devices

P

= Pharmacology

ME = Monitoring equipment ECG and defibrillator Pulse oximeter EtCO2 monitor

WFA Clinical Education Team


Airway Management Algorithms

Cormack and Lehane Airway Grading Scale

.

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Airway Management Algorithms

Difficult Cricothyrotomy

SHORT S = Surgery or other airway disruption H = Hematoma (includes infection/ Abscess) O = Obesity R = Radiation distortion T = Tumour

WFA Clinical Education Team


Airway Management Overview