1 Chapter 40 Advanced Airway Management 2 Advanced Airway Management The advanced airway management techniques discussed in this chapter are to

Transcription

1 1 Chapter 40 Advanced Airway Management 2 Advanced Airway Management The advanced airway management techniques discussed in this chapter are to introduce the EMT-B student to these procedures only. In Texas, these procedures are not normally performed by EMT-Bs. The exception to this is the Airway. This procedure will be discussed and practiced 3 Endotracheal Intubaton Insertion of a tube into the in order to maintain the airway Patients are only intubate who are: Unresponsive with no reflex In cardiac arrest Paramedics can use to make a patient unconscious and paralyzed to facilitate intubations EMTs do not intubate in Texas 4 Equipment (1 of 2) Proper-equipment endotracheal tube (ETT) handle and blade (visualized technique) Stylet or light 10-mL Oxygen, with BVM device 5 Equipment (2 of 2) A suctioning unit with rigid and soft-tip catheters forceps Towels for raising the patient s head and/or shoulders A stethoscope -soluble lubricant for tubes and scopes A commercial securing device or tape 6 Laryngoscope Sweeps the tongue out of the way and aligns the airway Has a light powered by in handle Has blades that connect to handle Blades are curved or. They range in size from 0 to 4. 7 ET Handle and Blades 8 Endotracheal Tubes Tubes come in many sizes, from to infant. Diameter for normal adult male ranges from to 8.5 mm. Diameter for normal adult female ranges from to 8.0 mm.

2 Diameter for normal adult female ranges from to 8.0 mm. Use tape or chart for sizes. 9 Stylet Plastic-coated wire may be inserted in the ETT to add rigidity and to the tube. Bend the tip of the stylet to form a gentle in adults. Bend the tip of the stylet to form a tip shape for an infant and child. Confirm that the stylet is not sticking out past the end of the ETT. 10 Syringe Use the 10-mL syringe to test for air in the ETT before intubation. After the ETT has been properly inserted, inflate the cuff with to ml of air. the syringe from the pilot balloon to prevent air from leaking. 11 Other Equipment A unit A BVM device forceps Towels for raising the patient s head or shoulders Secondary confirmation device (capnometer) C-collar and backboard 12 ET Equipment 13 The Intubation Procedure (1 of 2) Open the. Insert an oral airway. One EMT ventilates as the other equipment. Confirm that the patient has been pre-oxygenated. Position the. 14 The Intubation Procedure (2 of 2) Grasp the laryngoscope handle with the hand. Move the tongue to the left using the laryngoscope. Insert the ETT between the cords. Confirm placement of the ETT with stethoscope. the ETT in place. 15 Intubation 16 Vocal Cords

3 15 Intubation 16 Vocal Cords 17 Intubation Complications Intubating the main stem bronchus Intubating the esophagus Aggravating spinal injuries Taking too long to ventilate 18 Multi-lumen Airways Inserted without visualization Provide ventilation when placed in either trachea or 19 Esophageal Tracheal Combitube (ETC) 20 Combitube 21 Combitube Contraindications Conscious or semiconscious patients with gag reflex Children younger than years Adults shorter than Patients who have ingested a substance Patients with esophageal disease 22 Inserting the ETC (1 of 2) Assemble and check the proper. Apply water-soluble lubricant to the ETC. the patient. Pre-oxygenate the patient. Lift the lower jaw and. 23 Inserting the ETC (2 of 2) Guide the ETC along the base of the tongue until are between lines Inflate both balloons. Ventilate the patient in lumen #1 first. placement. If no lung sounds or chest rise, ventilate in lumen #2 Secure device the patient. 24 More on the Combitube If ventilations produce chest rise and adequate lung sounds while ventilating in tube #1, then the Combitube is in the Drugs may NOT be administered via the Combitube If ventilations produce chest rise and adequate lung sounds while

4 Drugs may NOT be administered via the Combitube If ventilations produce chest rise and adequate lung sounds while ventilating in tube #2, then the Combitube is in the Drugs MAY be administered via the Combitube 25 Removing the ETC Be prepared to patient. both balloon cuffs. Gently remove the tube. Note: removal of the Combitube in the prehospital setting is very 26 King Airway(Single Lumen Airway) 27 King Airway Single lumen esophageal device Used by all airway device for EMTs in this areas Secondary device for Intermediates and Paramedics; if unable to 28 King Airway 29 Advantages/Disadvantages of King Airway Only 1 ventilation port No need to determine Placement is esophagus only; very slim chance of tracheal placement Allows placement of gastric tube (in LTS-D) No ET route for Will not help with airways 30 Types King Airway : No port for gastric tube King Airway Has port for tube 31 King Airway Types LT-D 32 Adult King Airway Sizes Size Tall flange Inflation: 40-55cc s Size Tall

5 flange Inflation: 40-55cc s Size Tall Flange Inflation: 50-70cc s 33 Pediatric Airway Sizes Available only in LT-D Size Tall flange Inflation per instructions Size Tall flange Inflation per instructions 34 Indications For EMTs Unconscious and no reflex 1st line airway control device For Intermediates and Paramedics After unsuccessful attempts Secondary or device 35 Contraindications with gag reflex Under 35 tall (2 11 ) Ingestion of substances Patients with known esophageal disease 36 Procedure (1 of 6) Select appropriate based on patient s height Test cuffs (remove air) Apply water-based lubricant Pre- Position patient in or neutral position 37 Procedure (2 of 6) Holding the King at the connector with hand, hold the patient s mouth open and apply chin lift unless contraindicated due to trauma and/or immobilization 38 Procedure (3 of 6) With the King rotated laterally degrees, such that the blue

6 38 Procedure (3 of 6) With the King rotated laterally degrees, such that the blue orientation line is touching the of the mouth, introduce tip into the mouth and advance behind the base of the tongue, Never the tube into position 39 Procedure (4 of 6) As the tip passes under tongue tube back to midline (blue orientation line faces chin). Without exerting excessive force, advance the King until base of connector aligns with or gums. 40 Procedure (5 of 6) Inflate the cuffs based on the listed volumes for the tube size used. Attach BVM and verify placement by ALL of the following criteria: Rise and fall of Bilateral breath epigastric sounds Secure Tube 41 Procedure (6 of 6) If there is any question about the proper placement of the King Airway, the cuffs and remove the airway, Ventilate the patient with BVM for 30 seconds and repeat insertion procedure Continue to the patient for proper airway placement throughout prehospital treatment and transport 42 Key Points Must guess the patient s Not used for any patient under 35 tall Attach if an adult in cardiac arrest 43 ResQPod 44 ResQPOD ResQPOD is an Impedance Threshold Device ( ) Provides Perfusion on Demand (POD) by regulating pressures in the thorax during states of AHA 2005 Guidelines designated the ITD as a Class IIa recommendation (highest recommendation) for patients in cardiac arrest Higher recommendation than any drug 45 How It Works (1 of 3) During normal CPR, air flows in and out of chest during compressions Compression increases in the lungs, which forces small puffs of air out of the open airway

7 45 How It Works (1 of 3) During normal CPR, air flows in and out of chest during compressions Compression increases in the lungs, which forces small puffs of air out of the open airway As the chest recoils during the decompression phase, a slight sucks the small puff of air back into the airway in an effort to equalize the intra- and extrathoracic pressures. 46 How It Works (2 of 3) An ITD temporarily blocks, or impedes, the airway immediately the compression when exhalation releases the puff of air Chest recoil proceeds normally, but air rush into the airway to equalize the pressure The rapidly expanding intrathoracic space pulls blood into the heart from the great vessels resulting in improved blood (pre-load) to the heart 47 How it Works (3 of 3) Prevents unnecessary from entering the chest during CPR As the chest recoils, the vacuum (negative pressure) in the thorax is This vacuum pulls more blood back into the heart, doubling blood flow Increases cardiac, BP, and survival rates 48 Benefits of the ResQPOD blood flow to the heart Increases brain blood flow by 50% Doubles systolic BP Increases rates Increases likelihood of successful defibrillations Beneficial in all arrest rhythms Circulates drugs more effectively Timing for ventilations 49 Indications in cardiac arrest Onset of puberty Not for use in infants and NOT indicated for apneic patients with a heart beat; only cardiac arrest No compressions=no 50 Use on a BVM or Mouth to Mask Connect to face mask, remove light Open airway

8 Connect to face mask, remove light Open airway Establish/MAINTAIN a tight seal. Best accomplished with rescuers Connect BVM compression per light flash Ventilate after each compressions (3 light flashes) 51 Use With ET or King Airway placement Connect to airway device and BVM, remove light tab Perform compressions Ventilate with every light (10/min) 52 Key Points of ResQPOD Used only on in arrest If patient regains pulse and/or spontaneous respirations, the ResQPOD, but continue to ventilate as needed MUST maintain a constant seal if using with BVM only 53 Other Points These are ($100 each) so do not open unless you are going to use it. They do have dates