Airway Stepping Stones

An ongoing collection …

 

Have suction(s) on and ready and head of bed up As Soon As Possible for all airways: BLS BVM SGA ETT and/or FONA

If there is time, do a formalized checklist

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No space intubations


Originally posted in my Facebook community page #TBayAirBasedRounds
More to add regarding bougie for this too

Optimizing position

Right paraglossal straight blade

VL but minimize hyperangulated approach and hyperangulated styletting/bougie

Scope via SGA

Bougie via rigid suction (HT @jducanto see below) or VL/IL channel or CMAC left side channel

Surgical is your last resort (actually ECMO is?)

Resuscitation Sequenced Intubation Toolkit

Resuscitation Sequenced Intubation – HT Rich Levitan

These are some resources that can be used during an intubation: checklist, quick reference drug doses and contraindications, order sets on labels and post-intubation checks and briefing/debriefing tools. In addition, a quick reference teaching tool is included describing set-up, response to desaturation, response to challenges for intubation are also included.

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Recipe for SALAD (Suction Assisted Laryngoscopy Airway Decontamination) Simulation AKA “VomiQuin”

Make electrical safety a top priority with this setup, please.

Here are the basic construction instructions to create the Suction Assisted Laryngoscopy Airway Decontamination (SALAD) simulator (AKA “VomiQuin”) from the airwayNatic @jducanto.

SALAD simulation setup

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Bougie-Assisted Tactile Blind Digital Intubation

Yen Chow and Jorge Cabrera [Updated Sept 21, 2015]

A cardiac arrest has been called on the floor and you happen to arrive before the crash cart. CPR is in progress and mask ventilation is being performed with an oral airway. A lot of suctioning is required for vomit in the airway. There is difficulty ventilating despite optimizing position, two person bag-valve-mask ventilation, additional nasal airways and maximal jaw thrust. There is limited access to the head of the bed in the patient’s room. As an airway clinician on the code blue team you carry a bougie and a cuffed 6.0 endotracheal tube with you. Bougie assisted blind digital intubationIntubation and extraglottic airway equipment still has not arrived. Pulling out your bougie and tube, you take out the patient’s dentures and use the oral airway as a bite block. You find the epiglottis with your middle and index fingers inserted into the mouth and guide the bougie into the glottic opening feeling tracheal ticks and hold-up to confirm. The tube slides over the bougie. Successful ventilation occurs without chest compressions missing a beat and the code continues.

 

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