Airway

Mary Osinga

Ontario Air Ambulance

Sir Sandford Fleming College

Structure Review

Why an Airway Review

• Obese Patients

• Trauma Patients-changes to airway

• ‘Cause it can get ugly out there! Bad taping job!

Obese patients

Cricoid Pressure

What the heck are we lookin’ for?

This is not so good!

Get out of jail free cards?

• Laryngeal mask airway

• Combitube

• Lighted stylet

• Gum Elastic Bougie

• Digital intubation/Ice pick method

• Surgical Airway

Get out of Jail free….

LMA

LMA Procedure

Procedure:

-Hyper oxygenate

-Check cuff

-Lubricate posterior cuff

-Head in neutral or slightly flexed position

-Insert following hard palate (use index finger to guide))

--Advance using index finger– Use curve to advance over base of tongue– pushed as far as possible into hypopharynx– Stop when resistance felt (upper esophag. sphincter)

--Let go and inflate cuff (visualize “pop”)

-Confirm and secure

Get out of Jail free….

Gum Elastic Bougie

Get out of Jail Free

Lighted Stylet

• Indications– Impossible Laryngoscopy with adequate

Bag-Mask-Ventilation• TMJ ankylosis• limited C-spine mobility• facial trauma

• Contraindications– Upper airway masses or lesions (blind

technique)

Get out of Jail- Final Parting Shot!- Surgical Airway

Indications

-Obstruction

-Facial Trauma

-Intubation or other alternatives impossible

-Trismus (clenching)

->8 years old (for open procedures)

Surgical AirwaysNeedle Procedure:

-Identify Cricothyroid membrane

-Pierce at 45° angle

-Place catheter or stylet

-Advance dilator per manufacturer’s recommendation