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Dr. Gibbs' and Bullard's Airway master course

8/1/2013

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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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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction