Airway Management Tutorials

Introduction

Yukon EMS Medevac Wing utilizes a varied armamentarium of airway management tools in order to maintain or restore oxygenation and ventilation in the patients we care for. The following is a series of tutorials collected for the purpose of augmenting the information presented in the skills section of the YEMS clinical guidelines. Also featured will be clinical pearls designed to augment practice in the lab setting as well as in the field.

Basic Airway Management

The foundation of advanced airway management is solid basic life support skills. The recognition of respiratory failure or arrest and intervening without delay, can mean the difference between stabilization and deterioration. An ability to competently manipulate the airway, place airway adjuncts and deliver effective positive pressure ventilation's with a bag valve mask, will buy the patient time until advanced equipment can be readied and applied.



The following are pearls specific to our program:

• Test the BVM for proper functioning during routine equipment checks.




• Mentally visualize location of equipment so that when it is require it can be obtained without thinking.




• Practice the skill on the airway management trainer and/or Stat Man regularly.

Subglottic Rescue Airways

The two subglottic rescue airways used by YEMS Medevac wing are the King LTD and the LMA. The LMA is only carried in the flight bag, whereas the King LTD is carried in both the ALS and BLS ground jump bags. Practitioners are to become equally familiar with each device, yet expect to use the King LTD for the majority of times where a rescue airway is necessary. The use of the LMA is a device employed for the pediatric population because the King LTD has a patient size limit of 4 ft or greater.

The rescue airway is to be employed by the ALS practitioner after a failed endotracheal attempt has occurred, or a a primary ventilation device when the use of a BVM and airway adjunct is impractical due to space or has failed due to failure to maintain an appropriate mask seal.




Additional Points:

• Place the instruction card on the patients chest in order to assist in remembering the sequence of steps in applying the device.




• Remember to auscultate lung sounds and assess chest rise and fall to confirm adequacy of ventilation.




• Unless time is a factor (such as in the case of cardiac arrest), use the commercial Stabletube securing device instead of tape to secure the device externally.

Additional Points:

• Only one finger should be used to place the LMA in smaller pediatric patients




• All of the same indications and contraindications apply to the LMA as to the King LTD




• Secure the device withe the Stabletube securing device or tape after primary and secondary confirmation has been completed

Both of these devices can be exchanged with an endotracheal tube with the aid of a Bougie inserted into the lumin of the devices and advanced into the trachea. (more on this later)

Suctioning Subglottic Airways

Here is a demonstration of how to do this. You might know who the presenter is for this video.

Endotracheal Intubation

The following is a graphic example of the peformance of larygoscopy and endotracheal tube placement. It is meant to enhance your baseline knowledge of the skill and not as an end in itself. Completion of the forthcoming airway package is necessary in order to understand all of the equipment and assessments required prior to passing the tube.



Now that the procedure has been shown, check out the anatomy and landmarks that you have read about on a cadaveric model. Thanks Airwaycam!

In order to better visualize the landmarks and achieve an optimal view of the tracheal inlet, let us take a look at bi manual laryngoscopy.





The Bougie (trach tube introducer)

Another practical device that is carried in both the ground and flight bags is the bougie or trach tube introducer. First demonstrated as a device for the cure for intractable ciphilus in the male patient, in the 19th century, the device became an adjuct for the intubation of the difficulty airway in the 194os. The bougie can be a useful adjunct for the difficult airway or when the clinician needs to replace a rescue airway with an endotracheal tube.




Cricothyroidotomy

As a tertiary airway that our program carries is the Cook Melkar Crikothyroidotomy Device. Utilizing the Seldinger Techneque, the device minimizes the risk of blind space canulation and laceration of the great vessels.