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Basic Airway Management
• Open the airway– Chin lift– Jaw thrust– Oropharyngeal airway– Nasopharyngeal airway
Airway stabilization
Head Tilt/Chin Lift
Jaw Thrust
Oropharyngeal Airway
Nasopharyngeal Airway
Bag-Valve Mask
• Important to master!• 1 person vs 2 person BVM
1 Person BVM
• 2 thumbs up• 4 fingers jaw• Jaw thrust• Adjuncts
2 person BVM
Positioning
Pediatric Positioning
Airway Assessment
• Reason for intubation • AMPLE history• Exam: LEMON• 3-3-1
Difficult to Intubate (LEMON)
• Look at head and neck• Evaluate 3-3-1• Mallampati score• Obstruction: hot potato voice, secretions,
stridor• Neck mobility
3-3-2
Mallampatti Score
Difficult to Intubate (LEMON)
• Look at head and neck• Evaluate 3-3-1• Mallampati Score• Obstruction: hot potato voice, secretions,
stridor• Neck mobility
RSI: Induction• Ketamine (2 mg/kg)
– Good for hemodynamically unstable
– Good for obstructive airway
– Safe in intracranial hypertension
• Midazolam (0.3mg/kg)
• Propofol (2 mg/kg)
– HTN, sympathomimetic
– Disappears quickly (i.e. before paralytic does)
RSI: Paralysis
• Succinylcholine 1.5 mg/kg– Shorter time onset (30second), duration (10
minutes)– Contraindications
• Hyperkalemia, Burns, Neuromuscular
• Vecuronium 0.2 mg/kg – Longer time onset (60s) and duration (30min)
Intubation Technique
Placing tube• Optimize Patient Positioning
• Scissor Mouth, assistant pulls right corner
• Insert laryngoscope right
• Sweep tongue left
• Visualize epiglottis “up and out” not rock
• External laryngeal manipulation “bimanual intubation”
• Keep your eye on the prize
• Place and confirm placement
Post intubation
• Confirmation:– Visualize passing cords– Fog in tube– Bilat breathsounds, no gastric– CO2 detector– Chest X-ray
• Tie or tape tube • Sedation!