Advanced airway decisions

Paul Satterlee MD FACEP

Allina Health EMS

Conflicts of Interest

• I have no financial conflicts related to the content of this discussion

Objectives

• Review typical difficult airway management suggestions

• Apply these interventions to cases

• Discuss new ideas on advanced airway management

Decision Making

To intubate or not

Predict the difficult airway

• LEMON

• Look• Large incisors

• 3-3-2

• Mallampati

• Obstruction

• Neck mobility

What about this?

Your Skill is the Decision

• To intubate

• More consistent positive pressure and peep for increased oxygenation

• Control of rate and tidal volume to optimize ventilation

• Fluid control (Vomit)

• Not to intubate

• Head injury victims may do worse

• VAP rates are 8-28%, with a 25-50% mortality

• Hyperventilation

Simple aids

• Backwards, upwards and rightward procedure

• Bimanual manipulation

Positioning

• Towel roll?

• Ears to sternal notch

• Dr. Rich Levitan

Obstruction

• Suction works great for blood, but what about pizza?

• MacGills

Needle Cric

Case

How goes that physical exam?

Case 2

Best Case