Difficult Airway Management

Course overview

Objectives Describe the anatomy of the respiratory system and the role it plays in airway management Correctly implement tools designed to grade or assess airway difficulty Describe the equipment used to manage a difficult airway Explain the process and equipment used to gauge the success of an airway intervention Recognize factors that may indicate airway compromise or the likelihood of impending airway compromise Content I Airway Anatomy B Upper Airway Tract 1 Nose 2 Mouth and Oral Cavity 3 Jaw 4 Pharynx a Nasopharynx b Oropharynx c Hypopharynx d Laryngopharynx i Vallecula a Pyriform Sinus 5 Larynx a Cartilages i epiglottis ii arytenoid cartilage a corniculate cartilage b cuneiform cartilage c posterior arytenoids iii vocal cords a false vocal cord b true vocal cord iv thyroid cartilage v cricoid ring a arch of cricoid cartilage b lamina of cricoid cartilage c cricothyroid membrane ligament b Bone i Hyoid bone a Hyo epiglottic ligament C Jugular notch D Lower Airway Tract 1 Trachea Spatial relationship to esophagus 2 Carina Angle of Louis 3 Bronchi 4 Lungs a Bronchioles i bronchial smooth muscle ii beta two adrenergic receptors b Pulmonary cilia c Alveoli Surfactant E Support Structures 1 Chest Cage a Ribs b Muscles of respiration i intercostal muscles ii diaphragm c Pleura i parietal pleura ii visceral pleura 2 Phrenic nerve 3 Mediastinum II Airway Assessment A Purpose 1 Identify inadequate airway 2 Identify an unstable airway 3 Identify potentially difficult airways B Procedure 1 Gag Reflex 2 Airway obstruction a Soft tissue obstruction b Foreign bodies c Complete and incomplete d Upper vs Lower 3 Work of breathing 4 Laryngospasm 5 Laryngeal edema 6 Penetrating injuries C Anticipating the difficult airway 1 Trauma bleeding 2 Vomiting 3 History 4 Mouth opening 5 Mandibular length 6 Mallampati classifications 7 Obstructions 8 Neck mobility 9 Facial hair III Techniques of assuring a patent airway A Manual airway maneuvers B Mechanical airway devices C Relief of Foreign Body Airway Obstruction 1 Refer to current American Heart Association guidelines 2 Removal of foreign body airway obstructions using direct laryngoscopy a Purpose b Indications c Contraindications d Complications e Procedure f Limitation 3 Airway suctioning a Review and elaborate on the upper airway suctioning material from the EMR EMT and AEMT levels b Tracheobronchial Suctioning i purpose ii indications iii contraindications iv complications v procedure vi limitation D Blind insertion airway devices E Endotracheal intubation 1 Direct laryngoscopy visualized a Purpose b Indications c Contraindications d Complications e Procedure including confirmation techniques f Limitations 2 Non visualized a Nasal i purpose ii indications iii contraindications iv complications v procedure including confirmation techniques vi limitations b Digital i purpose ii indications iii contraindications iv complications v procedure including confirmation techniques vi limitations c Lighted stylet i purpose ii indications iii contraindications iv complications v procedure including confirmation techniques vi limitations d Fiber optic Shikaini Seeing Optical Stylet SOS Glide scope i purpose ii indications iii contraindications iv complications v procedure including confirmation techniques vi limitations F Percutaneous cricothyrotomy 1 Purpose 2 Indications 3 Contraindications 4 Complications 5 Procedure including confirmation techniques 6 Limitations I Comprehensive ventilation assessment A Purpose B Procedure C Minute Volume D Alveolar Volume E Evaluating the effects of artificial ventilation F Pulse oximetry 1 Purpose 2 Indications 3 Contraindications 4 Complications 5 Procedure G Blood gas analysis 1 pH 2 PaCO2 3 PaO2 4 Bicarbonate 5 Base deficit H Capnography Review 1 Purpose 2 Indications 3 Contraindications 4 Complications 5 Procedure II Review of ventilation devices used by EMRs EMTs and AEMTs A Manual devices 1 Purpose 2 Indications 3 Contraindications 4 Complications