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Dr. Gibbs' and Bullard's Airway master course

8/1/2013

0 Comments

 
Picture
Approach to Airways
  • Identify anatomical and physiological concerns
  • Think about approaches you should not use
  • Identify your primary and backup plan, verbalize it to everyone in the room

As airway attempts increase, adverse event rates increase
  • For 2 or fewer attempts, there is a 9% adverse event rate
  • For 3 or fewer attempts, there is a 35% adverse event rate
Make your first attempt your best attempt!


Mnemonic for difficult BVM:
  • Mask seal
  • Obesity
  • Aged
  • No teeth
  • Stiff Lungs

Mnemonic for evaluation for direct laryngoscopy:
  • Look externally
  • Examine the airway 3-3-2 rule
  • Mallampati
  • Obstruction
  • Neck Mobility
Picture
Thank goodness Dr. Chang is nearby to help Dr. Keller out in his time of need.
MORE CORE CONCEPTS TO KEEP AT THE FRONT OF YOUR MIND
  • 4 fingerbreadths above the sternal notch approximates the cricothyroid membrane.
  • Most important minute of intubation is the minute of preparation prior to intubation.
  • Avoid bagging, unless the patient is hypoxemic, in order to avoid regurgitatino/aspiration.

Complications of succinylcholine:
  • Hyperkalemic Crisis
  • Bradycardia/Asystole (2nd dose, children)
  • Malignant Hyperthermia
Other Rx Concepts
  • Succinylcholine can be used in burn and spinal cord injury patients early, but not after 72 hours after the acute event/injury.
  • Etomidate does cause adrenal insufficiency but there is no difference in mortality compared with other agents.
  • Ketamine is likely safe in patients with head injury and increased ICP.
  • Ketamine is a good choice for the hypotensive septic patient (as it augments cardiac output).
  • Cricoid pressure does not decrease risk of aspiration and worsens view. Rather try bimanual laryngoscopy.
BONUS Airway Concepts
  • For fiberoptic intubations, load the ETT in the patient, rather than on than on the fiber scope 
  • Less than 5-8 years old, surgical airway = transtracheal "jet" ventilation
Picture
"Transtracheal Ventilation is AWESOME! By the way, can someone find this head's body?"
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  • Home
    • 2018 MATCH
    • Our Curriculum
    • Our Fellowships
    • About Our Residents
    • About Charlotte
    • Prospective Applicants
    • Contact Us
  • About CMC
  • MEDICAL STUDENTS
    • Prospective Medical Students
    • Healthcare Disparities Externship
    • Current Students
  • Rotations
    • PGY - 1 >
      • Intern Orientation Month
      • ED 2 - Wound Care
      • ED 3 - Airway
      • ED 4 - GI
      • ED 5 - Emergency General Surgery
      • MICU
      • Pediatrics
      • Trauma
      • Orthopedics
      • OB/GYN
      • Cardiology
      • Ultrasound/Anesthesia >
        • Sonogames hints & tips
        • Ultrasound TV probe Cleaning
    • PGY - 2 >
      • ED 1 - Neurology
      • ED 2 - Renal/GU
      • ED 3 - Endocrine
      • ED 4 - EENT
      • ED 5 - ID
      • Pediatric EM
      • DHU - CCU
      • STICU
      • Toxicology
      • EMS
    • PGY - 3 >
      • ED 1 - MSK
      • ED 2 - Respiratory
      • ED 3 - Heme/Onc
      • ED 4 - Immunology
      • ED 5 - Environmental
      • ED 6 - Integumentary/Derm
      • ED 7 - Psych
      • ED 8 - Special Situations
      • PICU
      • Electives
  • Conference
    • Master Schedule
    • Carolinas Core Concepts
    • Individualized Interactive Instruction
  • Education
    • Simulation
    • Blogs >
      • EM GuideWire
      • CMC ECG Masters
      • #FOAMed
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
    • Board Review
    • Journal Club >
      • Resident Journal Club
      • Disaster Medicine Journal Club
      • Global Medicine Journal Club
      • Health Policy Journal Club
  • On Shift
    • Top 20
    • Clinical Quick Links
  • Chiefs Corner
    • Admin/Contact Numbers
    • Evaluations/Interview Season
    • Job Search
    • Moonlighting >
      • AEC Moonlighting
      • Cardiac Rehab
    • Schedules >
      • Block Schedule
      • ED Shift Schedule
      • Journal Club/OBP/Audits Schedule
      • Resident Lecture Schedule
      • Case Conference
      • Simulation Schedule
    • Wellness Section >
      • Upcoming Events
      • Places to go