Airway Management

2019 ◽  
Author(s):  
James M. Dargin ◽  
Lillian L. Emlet
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Endotracheal Intubation ◽  
Critically Ill Patients ◽  
Supraglottic Airway ◽  
Positive Pressure ◽  
Emergency Airway ◽  
Rapid Sequence ◽  
Bag Mask Ventilation ◽  
Upper Gastrointestinal

Endotracheal intubation is a commonly performed procedure in the intensive care unit (ICU). Active upper gastrointestinal bleeding, emesis in the airway, and the presence of a cervical collar are just a few examples of conditions encountered in critically ill patients that can make endotracheal intubation difficult. Furthermore, critically ill patients usually require intubation because they have exhausted their physiologic reserve and can deteriorate rapidly due to vasodilation from induction medications, reduction in preload from positive pressure ventilation, hypercapnia and acidosis during periods of apnea, hypoxia from failed attempts at intubation, and an increase in intracranial pressure during laryngoscopy attempts. Up to one third of patients undergoing emergency airway management will develop serious complications, including hypoxemia, hypotension, aspiration, or cardiac arrest. Careful planning, provision of the appropriate equipment and personnel, and an understanding of an individual patient’s physiologic derangements can help to prevent complications during intubation.  This review 13 figures, 4 tables, and 27 references.  Keywords: airway, intubation, endotracheal, rapid sequence, pre-oxygenation, bag-mask ventilation, laryngoscopy, cricothyrotomy, supraglottic airway 

scholarly journals Airway management of an open penetrating neck injury

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 89-93 ◽  
Author(s):  
Nayer Youssef ◽  
Karen E. Raymer
Keyword(s):  
High Risk ◽  
Airway Management ◽  
Rapid Sequence Intubation ◽  
Positive Pressure ◽  
Small Subset ◽  
Global Management ◽  
Airway Injury ◽  
Rapid Sequence ◽  
Penetrating Neck Injury ◽  
Bag Mask Ventilation

AbstractAlthough penetrating neck injuries (PNIs) represent a small subset of patients presenting to the emergency department (ED), they can result in significant morbidity and mortality. The approach to airway management in PNI varies widely according to clinical presentation and local practice, such that global management statements are lacking. Although rapid sequence intubation (RSI) may be safe in most patients with PNI, the high-risk subset (10%) of patients with laryngotracheal injury require particularly judicious airway management. It is not known if RSI is safe in such patients, nor has there been reported use of videolaryngoscopy in patients with open PNI. Established principles of airway management in patients with an open airway injury include the avoidance of both positive pressure bag-mask ventilation and blind tube passage and the early consideration of a surgical airway. Because this high-risk subset may not be clinically apparent on initial presentation in the ED, such guiding principles apply to all patients with PNI until the nature of the injury is more accurately defined. In this report, we present the case of a patient who presented to the ED with a zone II open PNI, which occurred as a result of a stab wound.

scholarly journals Airway Management in the Pre-Hospital Setting

2020 ◽  
Author(s):  
Lamia Tawfik ◽  
Mohammad Al Nobani ◽  
Tarek Tageldin
Keyword(s):  
Airway Management ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hospital Setting ◽  
Morbidity And Mortality ◽  
Rapid Sequence Intubation ◽  
Medical Providers ◽  
Rapid Sequence ◽  
Research Findings

This chapter explores the different techniques and challenges faced by emergency medical providers during pre-hospital airway management of critically ill patients. It is a crucial topic that has a major impact on patient’s safety. Improper airway management in this category of patients can lead to catastrophic results in terms of morbidity and mortality, this fact stimulates the ongoing improvement and evolution in this area of practice. We explore some of the debatable topics in pre-hospital airway management like airway management in the pediatric group, the use of medication assisted intubation and rapid sequence intubation in the field as well as the role of video assisted intubation and it’s challenges in the field. The up-to-date practices and research findings in the most recent related articles are discussed here in this chapter.

Mask Ventilation, Direct Laryngoscopy, and Supraglottic Airway Placement Procedures

2021 ◽  
pp. 17-36
Author(s):  
Jennifer Anderson
Keyword(s):  
Airway Management ◽  
Direct Laryngoscopy ◽  
Respiratory Arrest ◽  
Supraglottic Airway ◽  
Spontaneous Respiration ◽  
Positive Pressure ◽  
Mask Ventilation ◽  
Airway Patency ◽  
Bag Mask Ventilation ◽  
Respiratory Assistance

The basic skills required for competence in pediatric airway management include mask ventilation, supraglottic airway placement, direct laryngoscopy, and intubation. Although techniques used for children are similar to those used for adults, there are some nuances that pertain only to the pediatric patient. This chapter describes and illustrates these basic airway management procedures for pediatric patients. Bag mask ventilation is used extensively in the operating room, emergency department, and intensive care unit. Effective bag mask ventilation can save a child’s life in emergent situations.1 Respiratory assistance is provided to the patient through a mask on the patient’s face, held in a specialized way to maximize airway patency (described later), that is attached to a device capable of delivering positive pressure manually or automatically. Oxygenation is achieved by compressing air/oxygen through the delivery device into the lungs, and ventilation is ensured by maintaining airway patency as the patient exhales with chest wall recoil. Intubation is indicated in any patient who is unable to maintain adequate spontaneous respiration or who is at risk for aspiration. Examples are patients in respiratory arrest, those in cardiac arrest, or sometimes those experiencing neurologic issues such as seizures. Patients undergoing surgical procedures will often require intubation because of the apnea and risk for aspiration caused by the anesthetics and the surgical procedure itself.

scholarly journals (A179) A Survey of Rapid Sequence Intubation (RSI) Complications in Immam Hossein Medical Center Carried Out by Emergency Residents

2011 ◽  
Vol 26 (S1) ◽  
pp. s51-s52
Author(s):  
H. Hatamabadi ◽  
I. Golkhatir ◽  
A. Amini ◽  
M. Alavi Moghadam
Keyword(s):  
Emergency Medicine ◽  
Success Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Rapid Sequence Intubation ◽  
Emergency Airway ◽  
Emergency Medicine Resident ◽  
Rapid Sequence ◽  
Significant Difference

IntroductionCritically ill patients in emergency department frequently require emergency airway management. This procedure in our ED is carried out by emergency medicine resident with rapid sequence intubation (RSI). This study investigates complications of tracheal intubation carried out in critically ill patients including: (1) hypoxemia and hypotension (2) aspiration and esophageal displacement (3) pneumothorax and right bronchus intubation.MethodsData were collected on consecutive intubations carried out by EM residents over a 29 months period. Between 195 patients only 100 patients had including criteria to enter this study. Also we compare the complications and success rate among three level of personnel carrying on the procedure.(first to third year of emergency medicine residency).Results109 consecutive intubations were carried on in 100 patients. Oral translaryngeal intubation was done in all patients. Three intubations required more than 2 attempts and hypoxia occurred in 34 cases. Aspiration was diagnosed by direct vision in 5 cases. Hypotension was found in 5 cases causing death in 3 of them during the intubation or in 30 minutes following the procedure. Esophageal displacement occurred in 10 of the attempts but all were recognized and reintubated. Success rate between three personnel levels are as follow: in first year residency 82% and in second year residency 94% and in third year residency is 100% (p = 0.014).There was not a statistically significant difference among these three groups considering the complications but the success rate should a difference between level 1 and 3 (p = 0.936). Multiple attempts did not increase the rate of complications. Mortality were dependent to hypotension (p = 0.019) and age (p = 0.001).ConclusionIn our study we did not find the results of RSI to be operator dependent as long as it was done by emergency residents. It is recommended to compare the results of RSI and non- RSI methods in a future.

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