Advanced Airway
新光醫院急診科張志華醫師
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Goals
Difficult airway? (clinical criteria)Difficult airway àPlan?
“Can ’t Ventilate/Can't Intubate ”(CVCI) situation àPlan?
Why do we intubate?
A:Protect and maintain patent airway B:Oxygenation or ventilation C: Severe shock
D: Coma / IICP / herniation
Ideal conditions
Ideal lighting, positioning, etc.Plenty of assistance
Time to prepare, plan, discuss Option to abort Empty stomach Back up available
Ideal Pt.
学历培训机构
Intact, clear airway Wide open mouth Pre-oxygenated
英语作文 中秋节
Intact respiratory drive
Normal dentition/good oral hygiene Good neck mobility
Not too thin, not too fat
Ideal Airway
times of your lifeIn Reality…
…
Identify a difficult airway
PHx PE
Thyromental distance “Lemon ”law
PHx
Rheumatoid arthritis Ankylosing spondylitis Cervical fixation devices
Thyroid or major neck surgeries Acromegaly
Klippel-Fiel Syndrome Pierre Robin Syndrome Reduced jaw mobility Epiglottitis Tumors
PE
Limited neck movement Neck surgical acars Kyphosis Burns
Trauma –maxillofacial / neck
ThyroMental (TM) Distance
From upper edge of thyroid cartilage to chin with the head fully extended
Short thyromental distance:àAnterior larynx
àLess space for tongue > 7 cm àEasy intubation < 6 cm àDifficult airway Relatively unreliable
Lemon Law
L ook externally (PE)E valuate the 3-3-2 rule M allampati O bstruction?N eck mobility
L: Look externally
Limited neck movement Neck surgical acars Kyphosis Burns
Trauma –
maxillofacial / neck
E: Evaluate the 3-3-2 rule
> 3 fingers from Jaw to Neck Jaw > 3 fingers wide
Open the mouth > 2 fingers
O: Obstruction?
Blood Vomitus Teeth Epiglottis Dentures
Tumors
Impaled objects
N: Neck Mobility
scatology
Spinal precautions Impaled objects Lack of access PHx and PE
Difficult Airway
> 3 attempts > 10 minutes
他們
…
> 3 attempts
> 10 minutes
A little pre-planning goes a long way …
Before RSIlane
Alternatives?
l
suffixBIPAP l BVM
l Nasal ETT
SOAP-ME
Backup: Anesthesiologist / ENT
During Intubation
Plans A, B, and C克里斯布朗
l
A : Another
黑头怎么治Position Blade Tube Person
l B : Bagging and blind
温泉英语
LMA / Combitube / retrograde
l
C : Cut or catheter
Surgical / needle
(can ’t intubate can ’t ventilate situation?)
>我想你日语
