Airway - EM Guidelines

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Airway

Laryngoscopy videos

Mallampati Classification

Cormack-Lehane Scoring

Difficult to Bag

Beard
Obesity
No Teeth
Elderly (>55)
Snores

Difficult to Intubate (Emerg Med J 2005; 22:99-102)

Look at head and neck
Evaluate 3-3-2
Mallampati
Obstruction
Neck Mobility
Saturation reserve (Ann Emerg Med June 2006)

Difficult Extraglottic Device

Restricted Mouth Opening
Obstruction: at or below the level of the larynx
Disrupted or distorted airway. If the seat or seal of the device is disrupted
Stiff lungs or cervical spine. Poor lung compliance or inability to extend neck may hamper seal

Difficult Cricothyrotomy

Surgery/Disrupted Airway
Hematoma
Obese/Access Problems (Can't get to neck)
Radiation
Tumor

McCoy Laryngoscope Blade

Needle-Bag Ventilation

(can connect without the tubing as well)

(spike from IV tubing)

Needle Insufflation

(the other port is the release valve)

(the other prong is the release valve)

Oxylator

Non-rebreather mask ~ 52% O2: Groombridge et al. ACADEMIC EMERGENCY MEDICINE 2016;23:342–346. Hayes-Bradley, et al. Ann Emerg Med. 2015;-:1-7.

Preoxygenate with NIV:

Baillard, Fosse, Sebbane Am J Resp Care 2006;174(2):171-177

Cricoid?

Can't compress esophagus >50%: Smith, Dobranowski, Yip. Anesthesiology 2003;99(1):60-64

Worsens view? Haslam, Parker, Duggan. Anesthesia 2005;60(1):41-47

Does not prevent aspiration: Butler Sen Emerg Med J 2005;22(11):815-816 Fenton, Reynolds. Int J Ob Anesth 2009;18(2):106-110

Intubate with HOB elevated: Khandelwal et al. Anesthesia and Analgesia. 2016 Apr;122(4):1101-7. Lee et al. British Journal of Anaesthesia. 2007;99(4):581-6. Turner et al. AJEM 2017.

Strayer Airway Slides: http://emupdates.com/wp-content/uploads/2010/06/Advanced-Airway-Management-Lecture.pdf

Suggamadex:

Can't intubate can't ventilate: 16mg/kg

1-2 twitches: 4 mg/kg

3-4 twitches: 2 mg/kg

Selection	File type icon	File name	Description	Size	Revision	Time	User
	Ċ	View Download	Analgesia first sedation	206k	v. 1	Oct 17, 2012, 4:09 PM	Kit Tainter
	Ċ	View Download	8 pts, paralyzed and intubated, connected to circuit but no ventilations, no desats >30 minutes (low pH).	485k	v. 1	Oct 13, 2011, 6:30 AM	Kit Tainter
	Ċ	View Download		141k	v. 1	Jul 19, 2013, 6:48 PM	Kit Tainter
	Ċ	View Download	The Experience of Complete Neuromuscular Blockade in Awake Humans	766k	v. 3	May 14, 2011, 1:14 PM	Kit Tainter
	Ċ	View Download		725k	v. 1	May 28, 2018, 6:22 PM	Kit Tainter
	Ċ	View Download	Mean functional recovery time 8.5 minutes (pt will already have desaturation)	2661k	v. 1	Oct 19, 2011, 8:21 AM	Kit Tainter
	Ċ	View Download	Weingart	488k	v. 1	Feb 18, 2017, 10:26 AM	Kit Tainter
	Ċ	View Download		681k	v. 3	Oct 12, 2010, 2:26 PM	Kit Tainter
	Ċ	View Download		258k	v. 1	Jul 24, 2016, 7:03 AM	Kit Tainter
	Ċ	View Download		255k	v. 1	Mar 15, 2013, 10:25 AM	Kit Tainter
	Ċ	View Download	140 healthy subjects, 37% absent gag reflex	314k	v. 1	Sep 27, 2011, 12:09 PM	Kit Tainter
	Ċ	View Download	120 pts, gag reflex vs videolaryngoscopy vs speech therapy, gag not predictive of airway reflexes	501k	v. 1	Sep 27, 2011, 12:10 PM	Kit Tainter
	Ċ	View Download		589k	v. 1	Oct 27, 2016, 12:56 PM	Kit Tainter
	Ċ	View Download		130k	v. 3	Jan 21, 2011, 12:10 PM	Kit Tainter
	ą	View Download		331k	v. 1	Oct 22, 2011, 9:22 AM	Kit Tainter
	Ċ	View Download	Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury	136k	v. 2	May 7, 2012, 3:38 PM	Kit Tainter
	Ċ	View Download	Bimanual laryngoscopy best, BURP, Cricoid worsen view	1024k	v. 1	Oct 15, 2012, 4:18 PM	Kit Tainter
	Ċ	View Download		11035k	v. 1	Oct 27, 2017, 5:43 PM	Kit Tainter
	Ċ	View Download	One Hand, Two Hands, or No Hands for Maximizing Airway Maneuvers?	81k	v. 3	Oct 18, 2010, 12:22 PM	Kit Tainter
	Ċ	View Download	National Audit Project (4), Royal College of Anaesthetists. Review of airway complications in UK. Ch 10 is ED/Remote settings.	4084k	v. 2	May 10, 2011, 8:14 AM	Kit Tainter
	ą	View Download		622k	v. 1	Oct 22, 2011, 9:22 AM	Kit Tainter
	Ċ	View Download	Levitan - Nasal Oxygenation During Efforts Securing A Tube	1297k	v. 1	Nov 24, 2013, 11:11 AM	Kit Tainter
	Ċ	View Download		356k	v. 1	Oct 12, 2016, 12:12 PM	Kit Tainter
	Ċ	View Download		177k	v. 1	Jan 22, 2012, 7:53 AM	Kit Tainter
	Ċ	View Download		1207k	v. 1	Nov 11, 2011, 12:22 PM	Kit Tainter
	Ċ	View Download		200k	v. 1	Nov 11, 2014, 7:15 AM	Kit Tainter
	ą	View Download		166k	v. 1	Jan 31, 2013, 8:45 AM	Kit Tainter
	Ċ	View Download		117k	v. 1	Oct 26, 2011, 10:37 AM	Kit Tainter
	Ċ	View Download	Strayer letter to the editor reviewing Cochrane	126k	v. 1	Oct 20, 2011, 6:34 AM	Kit Tainter
	Ċ	View Download		784k	v. 2	May 11, 2011, 7:46 PM	Kit Tainter

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