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Icu Emergency Airway Management

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Andrew Ferguson
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ICU Emergency AIRWAY MANAGEMENT Dalhousie Critical Care Lecture Series
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case History ,[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Anatomy….
Airway Exam ,[object Object]
Airway Exam ,[object Object],[object Object],[object Object],[object Object],[object Object]
Airway Anatomy….
 
Airway Exam ,[object Object],[object Object],[object Object]
Cormack-Lehane Laryngeal View
Definition Minimal Sedation -Anxiolysis Conscious sedation is the use of medication to minimally depress the LOC in a patient while allowing the patient to continually and independently maintain a patent A/W and respond appropriately to verbal commands or gentle stimulation. Chet Wyman, University of Maryland School of Medicine
Sedatives In The Ideal World ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],There are no drugs available which achieve these ideals!
Midazolam (Versed®) ,[object Object],[object Object],[object Object]
Midazolam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fentanyl ,[object Object],[object Object],[object Object],[object Object]
Fentanyl ,[object Object],[object Object],[object Object],[object Object],[object Object]
Etomidate ,[object Object],[object Object],[object Object],[object Object]
Etomidate ,[object Object],[object Object],[object Object],[object Object],[object Object]
Topical Anesthesia Each spray = 10 mg of lidocaine Maximum dose = 5 mg/kg i.e. for 70 kg patient =35 sprays!
3 sprays of lidocaine to each location + 3 sprays behind tongue
Airway Management
4 Questions ,[object Object],[object Object],[object Object],[object Object],Murphy et al CJA 2005 52:3
Basic Airway Management ,[object Object],[object Object],[object Object],[object Object]
OPA ,[object Object],[object Object],[object Object]
NPA ,[object Object],[object Object],[object Object]
Mask Ventilation Requires … ,[object Object],[object Object],[object Object],[object Object],[object Object]
2 Handed BVM
Difficult Ventilation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hung and Murphy CJA 2004 51:10
Can I ventilate this patient ?? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Predictors of Difficult Intubation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Merah NA et al CJA 2005 52
Can’t Intubate/Can’t Ventilate or Holy *@#& Phenomenon ,[object Object],[object Object],Benumof JL Airway Management Principles and Practice 1996:124.
Time to intubate . . . ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Position Your Patient ,[object Object],[object Object],[object Object]
What Size Endotracheal Tube ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What Laryngoscope ?
Laryngoscopy
Intubation Confirmation ! ,[object Object],[object Object],[object Object]
 
Airway Adjuncts
Cricoid Pressure ,[object Object],[object Object],[object Object]
Laryngeal Mask Airway ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Bougie ,[object Object],[object Object],[object Object]
Special Cases ,[object Object],[object Object],[object Object],[object Object]
Obesity ,[object Object],[object Object],[object Object],[object Object],[object Object]
Positioning Obese Patients The blue axis = ear to manubrium should be level
Rheumatoid Arthritis ,[object Object],[object Object],[object Object],[object Object]
C1 and C2 Anatomy
 
Head and Neck Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object]
Head and neck masses Epiglottis Glottic opening Supraglottic mass
C-spine Trauma ,[object Object],[object Object],[object Object]
In-line Stabilization
What about the Patient with Pneumonia? ,[object Object]
Answer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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ICU topics for Final FRCA
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Icu Emergency Airway Management