S2E4 - Airway Management

Airwayve

Check out this great video which summarizes the steps below: https://www.youtube.com/watch?v=8AOB2PtHfVM&ab_channel=InterAnest
Here are a few key steps in airway management:

Ask yourself:

• Will I be able to mask ventilate?
• Will I be able to perform laryngoscopy, directly or indirectly?
• Will I be able to intubate this patient?
• Is there a significant aspiration risk?

History and physical:

• Check your patients' anesthetic history for any record of a previously difficult airway.
• Difficult bag-mask - BONES: beard, obesity, no teeth, elderly, snoring (or OSA)
• Mouth opening & Mallampati score (high score = difficult laryngoscopy!)
• Thyromental distance (see below) and sternomental distance
• Mobility at the temporomandibular joint and prognathism

Managing the airway:

• Pre-oxygenate patient to end-tidal O2 of >80%
• Align the oral/pharyngeal/laryngeal axes via the "sniffing position"
  • Helpful tip! Place folded sheets, rolled blankets or a foam headrest underneath patients' neck to help achieve this position.
• Hold your Mac blade in your left hand; advance the blade to the vallecula while sweeping the tongue out of the way
• Apply pressure up to the corner of where the wall/ceiling meet to reveal the glottic opening and visualize the cords
• Describe the view of the cords using the Cormack-Lehane scale! If you can't see the cords, use the BURP maneuver
• Stop advancing the tube when you see the proximal end of the endotracheal tube is at 21-22 cm at the front teeth in an adult - then ask for the cuff to be inflated

Confirm tube placement:

• Auscultate for breath sounds
• Check capnography
• Look for symmetric rise and fall
• Celebrate with a little happy dance (in your head)

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