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

2. Airway Management

3. Airway Management

4. Airway Management

5. Airway Management

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

7. Airway Assessment
Look Externally
Evaluate the Rule

8. Airway Assessment

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

10. Airway Assessment

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

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

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

14. Why RSI?

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

16. 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

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

18. Preoxygenation

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

20. Paralysis with Induction
Cricoid Pressure / Sellick Maneuver
Defasciculation

21. Placement of Tube

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

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

24. Post-intubation Desaturation
Displacement
Obstruction
Pneumothorax
Equipment

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

26. 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