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Principles of Anesthesiology Nursing I Advanced Airway Management

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... Describe the follow-up and documentation following a difficult intubation Describe the indications and steps for Rapid Sequence Intubation (RSI) Rapid Sequence ... – PowerPoint PPT presentation

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Title: Principles of Anesthesiology Nursing I Advanced Airway Management


1
Principles of Anesthesiology Nursing IAdvanced
Airway Management Jeffrey Groom, PhD,
CRNADirector and Clinical Associate
ProfessorNurse Anesthetist ProgramFlorida
International University
2
Describe the technique for performing oral and
nasal intubation
3
Discuss the procedures for a difficult airway,
failure to intubate, failure to ventilate scenario
4
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5
ASA Difficult Airway Algorithm
6
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7
Difficult Airway Cart
8
  • Available Airway options
  • Nasal and Oral Airways
  • Intubating Stylets
  • Specialized Stylets
  • Airway Exchange Catheters
  • Esophageal Airways
  • Laryngeal Mask Airways
  • Rigid Fiberoptic Laryngoscopes
  • Flexible Fiberoptic Bronchoscopes
  • Retrograde Intubation
  • Cricothyrotomy Devices
  • Transtracheal Jet Ventilation

9
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11
Describe the criteria and steps for extubation
following a difficult intubationDescribe the
follow-up and documentation following a difficult
intubation
12
Describe the indications and steps for Rapid
Sequence Intubation (RSI)
13
Rapid Sequence Induction (RSI)
  • Aspiration prophylaxis
  • Airway Equipment - Suction
  • Optimize intubating conditions
  • Denitrogenate Oxygenate
  • STP SUX IV Push
  • Cricoid Pressure
  • No Bag Ventilation
  • Intubate
  • On emergence Awake Extubation

14
Describe the indications and steps of Awake
Intubation
What nerve blocks may be used in awake intubation?
15
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16
Peripheral Nerve Blocks
  • Awake Fiberoptic Intubation- Tracheal Blocks
  • Glossopharyngeal
  • Superior Laryngeal
  • Transtracheal
  • Oral Topicalization Prep
  • 2 - 3 ml LIDO

CAUTION Following topical block pt is without
airway reflexes!
17
glycopyrrolate
18
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19
What are the options for a surgical airway?When
is a surgical airway indicated?
20
Cant VENTILATE Cant INTUBATE SURGICAL AIRWAY
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23
Describe the criteria for extubation.Discuss
the potential complications following extubation
24
Emergence and Extubation
  • Spontaeous ventilation
  • Negative inspiratory force gt 20 cmH2O
  • Vital capacity gt 15 ml/kg
  • Regular respiratory pattern
  • Paralytics reversed
  • Equal grip strength, head lift gt 5 sec
  • Awake, responsive, stable VS

25
Post-extubation Complications
  • Laryngospasm
  • 100 FiO2 - Jaw thrust Positive Pressure
  • SUX 10 20 mg IV
  • SUX 100 mg IV and Reintubate prn
  • Hypoxemia
  • 100 FiO2
  • Hypoventilation
  • Inadequate reversal, opioids, pain, neurologic
  • Laryngeal edema
  • Racemic epi, steroids
  • Negative pressure pulmonary edema
  • Shivering
  • Blood loss

26
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