MLM Airway Mx

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<p>Approach to Difficult and Failed AirwayMohd Zakaria 19th August 2010</p> <p>Outline</p> <p>Definitions. Evaluations of Difficult Airway Equipments: Algorithm: -ACEP</p> <p>Definition</p> <p>Difficult Airway: Clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both.Practice Guidelines for Management of the Difficult Airway.An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology, V 98, No 5, May 2003</p> <p>Definition</p> <p>Difficult face mask ventilation: It is not possible for the anesthesiologist to provide adequate face mask ventilation due to one or more of the following problems: inadequate mask seal, excessive gas leak, or excessive resistance to the ingress or egress of gas.</p> <p>Practice Guidelines for Management of the Difficult Airway.An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology, V 98, No 5, May 2003</p> <p>Definition</p> <p>Difficult laryngoscopy: (a) It is not possible to visualize any portion of the vocal cords after multiple attempts at conventional laryngoscopy Difficult tracheal intubation: (a) Tracheal intubation requires multiple attempts, in the presence or absence of tracheal pathology. Failed intubation: (a) Placement of the endotracheal tube fails after multiple intubation attempts.Practice Guidelines for Management of the Difficult Airway.An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology, V 98, No 5, May 2003</p> <p>Definition</p> <p>A failed airway exists when one or both of the following scenarios occur: 1. Inability to ventilate or intubate the patients 2. Three intubation attempts by the same operator, even when O2 saturation able to be maintainPractice Guidelines for Management of the Difficult Airway.An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology, V 98, No 5, May 2003</p> <p>Evaluations for Difficult BVM Ventilation</p> <p>MOANS: MOANS Assesses the Potential for Difficult BagValve-Mask Ventilation Mask seal -Inadequate mask seal? Obesity/Obstruction -&gt;26 kg/m2 O Age -&gt;55 years No teeth -Impair BVM effectiveness Stiff ventilation -Asthma, COPD, ARDS, term pregnancyWalls RM and Murphy MF: Manual of Emergency Airway Management, 3rd edition, Philadelphia, Lippincott, Williams, and Wilkins 2008.</p> <p>Evaluations for Difficult LaryngoscopyLEMON: LEMON Assesses the Potential for Difficult Laryngoscopy </p> <p>Look -Injury, large incisors, large tongue, beard Evaluate 3-3-2 -finger-breadth measurement* Mallampati Score -3 Obstruction -Any condition causing obstruction Neck -Limited neck mobility *3= inter-incision; 3=floor of mandible; 2=thyroid to hyoid</p> <p>Reed MJ. Can an airway assessment score predict difficulty at intubation in the emergency department? Emergency Medicine Journal 2005; 22:99-102.</p> <p>Evaluations for Difficult LaryngoscopyThis study assessed the ability of the LEMON score to predict difficult airways. 156 ED patients had a LEMON score performed and correlated with the Cormack-Lehane score during laryngoscopy. 73% of patients were classified as easy intubations, and 27% were difficult intubations. Patients with large incisors [p </p>