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Title:

The Difficult and Failed Airway

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Presentation for use in Rapid Sequence Intubation Training Lectures. Last modified by: JC Created Date: 10/9/2001 5:12:02 PM Category: RSI Lectures – PowerPoint PPT presentation

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Title: The Difficult and Failed Airway


1
The Difficult and Failed Airway
  • Principles of Rapid Sequence Intubation
  • Jason Carter, B.S., L.P.

2
I. The Difficult Airway
  • Defined
  • Difficult to oxygenate and ventilate
  • Difficult to intubate
  • Difficult to perform a cricothyroidotomy

3
B. Predicting the Difficult Airway
  • LEMON law
  • Look externally
  • Evaluate the 3-3-2 rule
  • Mallampati classification
  • Obstruction ?
  • Neck Mobility

4
1. Look externally
  • Beard or Moustache that hinders seal of BVM
  • Abnormal Facial Shape
  • Extreme cachexia
  • Endentulous mouth with sunken cheeks
  • Disruption of the lower face due to trauma.
  • Large central incisors
  • High-arching palate
  • Receding mandible
  • Short bull neck
  • Morbid obesity

5
2. Evaluate the 3-3-2 Rule
  • Three finger mouth opening
  • Three finger mentum-to-hyoid
  • Two finger floor-of-mouth-to-thyroid cartilage

6
3. Mallampati classification
  • Spaciousness of mouth
  • Done sitting with head in sniffing position,
    mouth wide open and tongue sticking out

7
4. Obstruction
  • Foreign object Magill forceps
  • Laryngeal tumor
  • Known or suspected epiglottitis
  • Known or suspected peritonsillar abscess
  • Direct airway trauma
  • Extrinsic airway hematoma with compression

8
5. Neck mobility
  • Spinal motion restriction automatically makes the
    RSI difficult
  • Non-trauma patients should be able to bring their
    head into the sniffing position

9
II. Clinical Approach to the Difficult Airway
  • First complication is mechanics
  • Worst is esophageal intubation
  • Factors in failure vs. success

10
A. Clinical Techniques
  • Re-position the head non-traumatic
  • Jaw Lift in trauma patients
  • Miller blade for epiglottis
  • BURP technique
  • Leave inadvertent esophageal tube in place
  • 1 1.5 size smaller ETT

11
III. The Failed Airway
  • Failed airway defined
  • failure of single attempt at oral intubation
    followed by inability to maintain SpO2 ? 90 with
    BVM
  • Three failed attempts made by an experienced
    airway manager

12
B. Management of the Failed Airway
  • Cant intubate, can oxygenate has time
  • CombiTube Placement
  • Digital Intubation
  • Smaller tube
  • BURP
  • Cant intubate, cannot oxygenate immediate
    response
  • Needle or Surgical Cricothyroidotomy

13
Conclusion
  • General Ruleprepare for the worst and hope for
    the best
  • Before RSI, determine difficulty of intubation
    using LEMON law
  • All Spinal Motion Restriction patients are
    automatically difficult
  • Keep up intubation skills
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