Dr. Gibbs' and Bullard's Airway master course

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
  

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

"Transtracheal Ventilation is AWESOME! By the way, can someone find this head's body?"