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| *[[Intubation]]
| | ==Advanced Airway Adjuncts== |
| *[[Surgical cricothyrotomy]]
| | [[File:PMC4530924 wjem-16-588-g002.png|thumb|Emergency intubator demonstrating preloaded [[bougie]] technique on a mannequin.]] |
| *[[Supraglottic airway]]
| | [[File:Masques laryngés- LMA Unique et I-gel.jpg|thumb|Two example [[LMA]] airways.]] |
| **[[Laryngeal Mask Airway (LMA)]]
| | [[File:Barrel-connector.png|thumb|[[Pediatric jet ventilation]] setup.]] |
| *[[Pediatric jet ventilation]]
| | {{Advanced Airway Adjuncts Chart}} |
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| ===Endotracheal tube introducer (ETI)/Gum Elastic Bougie===
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| *Higher first pass success when used with direct laryngscope vs. styletted ET tube regardless of whether difficult airway was expected or not <ref>Driver, B. E., Prekker, M. E., Klein, L. R., Reardon, R. F., Miner, J. R., Fagerstrom, E. T., … Cole, J. B. (2018). Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association, 319(21), 2179–2189.</ref>
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| *Blind orotracheal intubation
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| ===Lighted Optical Stylets===
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| *High success rate - especially good for trauma, c-spine precautions
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| *Use for both reg and nasotrach
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| *Lower complication rate
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| *Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
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| ===[[LMA]]===
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| *Can use without muscle relaxants
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| *Better than face mask
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| *Can be used as bridge to fiberoptic intubation
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| *Limited by unreliable seal at peak insp pressure
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| *Aspiration risk
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| *Mucosal trauma
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| *LMA better than endotracheal for paramedics, especially in pediatric patients<ref>Zhu X-Y, Lin B-C, Zhang Q-S, Ye H-M, Yu R-J. A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation. Resuscitation. 2011;82(11):1405–1409. doi:10.1016/j.resuscitation.2011.06.010</ref><ref>Calkins MD, Robinson TD. Combat trauma airway management: endotracheal intubation versus laryngeal mask airway versus combitube use by Navy SEAL and Reconnaissance combat corpsmen. J Trauma. 1999;46(5):927–932</ref>
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| *Intubating LMA (LMA-Fastrach) provides the opportunity to convert to a definitive airway after rescue with the supraglottic device
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| ===Combitube- esoph obturator===
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| *Good for nurses and paramedics with limited intubation skill
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| *Indicated if difficult airway predicted: cannot see glottis with laryngoscope
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| *Reduced risk for aspiration compared to face mask or LMA
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| *Can maintain spinal immobilization
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| *Large size predisposes to esophogeal dilatation and laceration as a complication
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| ===[[Percutaneous transtracheal ventilation]]===
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| *PTV
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| *Prefered over crithyrotomy in children up to age 10-12
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| *Needle, 16-18ga through cricoid membrane, connected to 50 psi 02<ref>Beck, E., Kharasch, M., Casey, J., Ochoa, P., Menon, S., Calabrese, N. and Wang, E. (2011) ‘Percutaneous Transtracheal jet ventilation’, Academic Emergency Medicine, 18(5), pp. e38–e38.</ref>
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| **Oxygenates well
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| **Ventilate through glottis and upper airway - can retain CO2
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| *Need adequate oxygen pressure
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| *1 sec insp and 2- 3 sec exp to avoid breath stacking
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| *Can use for 30-45 min
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| *May cause pneumothorax or barotrauma
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| *Contraindications
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| **Distorted anatomy
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| **Bleeding diathesis
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| **Complete airway obstruction
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| ==See Also== | | ==See Also== |
| *[[Airway sizes (peds)]]
| | {{Related Difficult Airway Pages}} |
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| {{Related Difficult Airway Pages}}
| | ==References== |
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| [[Category:Critical Care]] | | [[Category:Critical Care]] |
| [[Category:Procedures]] | | [[Category:Procedures]] |
