Thursday, 22 September 2016

Basic Airway Management

I hope we're pretty good at this!

Hands:        head tilt chin lift or jaw thrust
Adjuncts:    oropharyngeal airway -hard to hard preferred (middle of incisors to angle of jaw). Soft to soft (tragus to corner of mouth alternative)
                     nasopharyngeal 6mm women, 7mm men (not patient's little finger)
                     supraglottic airway eg. IGel
Tube:           probably as an emergency RSI (see later)

Failed Intubation: 
DAS Guidelines are really simple now and are easy to remember and follow.
Plan A: Intubate
Plan B: Supraglottic
Plan C: Facemask. Paralyse
Plan D: Front of neck surgical cric

Difficult BVM Assessment
M: Mask seal – for example a beard or blood
O: Obesity (BMI >30) and obstruction (snoring history)
A: Age >55
N: No teeth
S: Stiff lungs

Difficult Intubation Assessment 
L: Look: a rapid ‘gut-feeling’ assessment
E: Evaluate the 3-3-2 rule
M: Mallampati score
O: Obesity/obstruction (stridor in particular is worrying)
N: Neck mobility

References and Further Links
http://learning.bmj.com/learning/modules/end/ELU.html?moduleId=10033823 
https://www.das.uk.com/files/das2015intubation_guidelines.pdf

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