Airway ManagementPart II

Adjuncts & Devices

Zachary Wm. Drathman

Equipment

Know what you need Find an area to work in Check your cuff Lube the tube Shape your tube appropriately Educate your EMTs Capnography

Laerdal’s

“The Bag” BVM

Utilize the “C” & “E” grip for a good seal

Save the Kung Fu grip for kicking ass!

“C” & “E” grip One handed!

Respect Your BVM

1. Delivers 100% O2

2. Every Engine has one3. Your very own CPAP4. 1600ml of 02 at your finger tips

5. EMT + BVM = adjustable ventilator

Top five reasons to love the BVM

Getting

sleepy

Make Your BVM Work For You!

Perfect for those CHFers: Improve gas exchange

Decrease V Q mismatchDecrease Work of Breathing (WOB)

No “Plastic Cigar” for those HODsMaintain O2 saturation while

providing better living through Pharmacology.

BVM: One size fits all?

Static BVM volume: 1600ml Normal human inhalation: 500ml Max inhalation: 3500ml Max exhalation: 1200ml Stuck inside: 2300ml

COPD (Asthma/Empysema)COPD (Asthma/Empysema)

Prolonged Expiratory PhaseProlonged Expiratory Phase

MmmmCigarettes!

Understanding Air Trapping

Bronchospasm leads to an inability to efficiently exhale

Increasing ventilatory rate compounds the problem.

Air Trapping in the COPDer

Healthy lungs: Supple, Elastic

Emphysema Lungs:Distended, Inflexible

You know what they say about big hands?

Firemen like to do things all or nothing.

Define what you are looking for: Volume, Rate, Flow

Listen for O2 flowing (or not) Monitor rate & volume being

delivered Check on status routinely Spread the word of Sellick

Sellick and Burping

“Cric Pressure” should be in every EMTs toolkit… But it’s not.

Very helpful for HODs requiring BVM. “I love the smell of vomit in the morning!”

Teach firemen how to BURP! Backward Up Rightward Pressure

So you got the tube.

Now what?

Colormetric Meter (CO2 Detector)

Colormetric CO2 Detection Devise

1. Inflate cuff

2. Remove syringe

3. Affix ETCO2 detector

4. Observe color change Purple > Yellow

Ascultate For Final Confirmation

1. Use quick shallow ventilations

2. Listen at epigastrum first

3. Listen at both lung fields

Dude! You forgot the syringe.

Shut up! They’re students. They

won’t even notice.

Capnographic Device{Medtronic Microstream EtCO2 Circuit}

Capnography

New devise for old concept.Old devise: ColormetricNew devise: Graphical / QuantitativeUses:

Tube confirmation (initial / ongoing)

CPR effectiveness

Numbers: 35 to 40 is greatAny number >10 means a good tube

Secure & Re-Confirm

Try for “22 at the teeth”

but let lung sounds be your guide

Apply Thomas tube holder

After securing

Always confirm tube placement:

After loadingBefore unloading

After unloading

Thomas Endotracheal Tube Holder

Route neck strap prior to intbubation.

Secure neck strap THEN clamp tube.

Laryngeal Mask Airway (LMA)

Rescue devise NOT tube replacement!

Periodic respiratory rate checkLifepak monitoring

With audible QRSKnow the character of your

patient’s ventilatory phaseSPO2 monitor on

EtCo2 monitor on

Monitoring

SPO2 Monitoring

Measuring the ratio of oxygenated hemoglobin to total hemoglobin

Two different wave lengths of light used

Carboxyhemoglobin gives falsely high reading

Dark skin may give falsely high reading (3%-5%)

Capnography Waveforms

Affecting EtCO2

Increased Ventilation >>> Decreased EtCO2

Decreased Ventilation >>> Increased EtCO2

However trapped CO2 will drive up EtCO2 readings.

Be alert to a prolonged expiratory phase.

Documentation

“He, who does not document will be blamed.”

Example:

"RSI, laryngoscopy x1, ETT size 7.5, 23cm at teeth, clear breast sound bilateral, positive CO2"

“Shit rolls downhill.”