Nicole McCoin, MD Stephan Russ, MD February 22, 2007

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Presentation transcript:

Nicole McCoin, MD Stephan Russ, MD February 22, 2007 Airway Management Nicole McCoin, MD Stephan Russ, MD February 22, 2007

Airway Management

Airway Management

Airway Management

Airway Management

Reasons for Intubation Airway Protection Inability to Oxygenate Inability to Ventilate Anticipated Clinical Course

Airway Assessment Look Externally Evaluate the 3-3-2 Rule

Airway Assessment

Airway Assessment Look Externally Evaluate the 3-3-2 Rule Mallampati Classification

Airway Assessment

Airway Assessment Look Externally Evaluate the 3-3-2 Rule Mallampati Classification Obstruction Neck Mobility

Pharmacologic Agents Induction Agents Etomidate (0.3 mg/kg) Fentanyl/Versed (0.1 – 0.3 mg/kg) Ketamine (1.5 - 3 mg/kg) Propofol (3 mg/kg)

Pharmacologic Agents Neuromuscular Blocking Agents Depolarizing Agents Succinylcholine Nondepolarizing Agents Vecuronium Rocuronium

Why RSI?

The 6 “Ps” of RSI Preparation Preoxygenation Pretreatment Paralysis with Induction Placement of Tube Post-intubation Management

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

Preparation Specifics Blade type / blade size Tube size for adults and pediatrics Minimum 7.5 ETT for bronchoscopy Pediatric ETT size = (age/4) + 4

Preoxygenation

Pretreatment Lidocaine 1.5 mg/kg Opioids / Fentanyl 3 mcg/kg Atropine 0.02 mg/kg Defasciculating Dose

Paralysis with Induction Cricoid Pressure / Sellick Maneuver Defasciculation

Placement of Tube

Placement of Tube Depth of tube Managing a failed intubation attempt 3x the diameter of the ETT Managing a failed intubation attempt

Post-intubation Management Confirmation of Tube Placement Post-intubation sedation +/- paralysis

Post-intubation Desaturation Displacement Obstruction Pneumothorax Equipment

The 6 “Ps” of RSI Preparation Preoxygenation Pretreatment Paralysis with Induction Placement of Tube Post-intubation Management

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