The Difficult Airway. The Difficult Airway. Difficult Airway Algorithms: ASA. Ectopic Anesthesia. Cancel Case. Awaken. airway. Defining ng the problem

Size: px
Start display at page:

Download "The Difficult Airway. The Difficult Airway. Difficult Airway Algorithms: ASA. Ectopic Anesthesia. Cancel Case. Awaken. airway. Defining ng the problem"

Transcription

1 The Difficult Airway The Difficult Airway Robert J. Vissers, MD FACEP Department of Emergency Medicine Legacy, Emanuel Hospital Defining ng the problem Defining ng the difficult d airway a Identifying ng the difficult d airway a Managing ng the difficult d airway a Difficult Airway Algorithms: ASA Cancel Case Fig 1 ASA DIFFICULT A AIRWAY ALGORITHM Anesthesiology 1996;84:686 Awaken Ectopic Anesthesia Problem: Urgency Cost of failure Formula for error 1

2 Emergency Airway Management Solution: Preparation Anticipate difficulties Simple, consistent, reproducible approach Difficult Airway Algorithms Common principles Assessment of ventilation difficulty Assessment of intubation difficulty Awake vs. induction and paralysis Calling for help Surgical airway is a potential endpoint Decision to intubate Approach to the Emergency Airway Decision to intubate Decision to Intubate Near death? Unresponsive? Difficult Airway? Rapid Sequence Intubation Crash Airway Difficult Airway Techniques Failed Airway Airway maintenance Oxygenation Ventilation Facilitate therapy Expected course Adapted from: Walls RM, Ed. The Manual of Emergency Airway Management Philadelphia, Lippincott,

3 Decision to Intubate: Modifiers Operator experience Setting Potential for a difficult airway Never take away what you cannot replace National Emergency Airway Registry (NEAR) Prospective airway registry n = 12,000 <1% fail rate with RSI Cricothyrotomy rate 0.6% No cases of cannot intubate, cannot ventilate with death The Difficult Airway DIFFICULT BAG AND MASK VENTILATION DIFFICULT LARYNGOSCOPY AND INTUBATION DIFFICULT CRICOTHYROTOMY SAKLES TRIANGLE 3

4 The Difficult Airway Assessment of Difficult BVM DIFFICULT BAG AND MASK VENTILATION DIFFICULT LARYNGOSCOPY AND INTUBATION DIFFICULT CRICOTHYROTOMY SAKLES TRIANGLE Assessment of Difficult BVM Consider potential difficulty of BVM ventilation before RSI Beware the full stomach Equipment out and ready Five predictors of difficult BVM: facial hair, obesity, adentulous,, elderly, snoring * *Langeron O, et al. Anesthesiology, Assessment of Difficult BVM: Bones M ask seal O besity/obstruction A ge > 55 N o teeth S tiff lungs 4

5 The Difficult Airway DIFFICULT BAG AND MASK VENTILATION DIFFICULT LARYNGOSCOPY AND INTUBATION DIFFICULT CRICOTHYROTOMY SAKLES TRIANGLE Assessment of Difficult Intubation Laryngoscopic view (Cormack-Lehane) too late Systems too complex, impractical Need simple, fast approach 5

6 Difficult Airway? LEMON Law L ook externally E xamine (3-3-2) M allampati grade O bstruction N eck mobility Adapted from: Walls RM, Ed. The Manual of Emergency Airway Management Philadelphia, Lippincott, Cognitive forcing strategies in clinical decisionmaking. P Croskerry. Ann Emerg Med Jan, LEMON: Look Simple visual inspection often reveals obvious potential difficulties 6

7 LEMON: Examine Assess oral opening - 3 fingers Measure the mandible - 3 fingers Position of larynx - 2 fingers LEMON: Examine Assess oral opening should be able to accommodate 3 fingers LEMON: Examine Measure the mandible - should be able to fit 3 fingers between the mentum and the hyoid bone 7

8 LEMON: Examine Assess position of larynx should get 2 fingers between the thyroid cartilage and the mandible 8

9 LEMON: Mallampati Class I Class II Class III Class IV LEMON: Obstruction? 1) Location? 2) Fixed or mobile? 3) Speed of progression? 9

10 LEMON: Neck Mobility Can the patient flex and extend the neck? Actively assess in the non-trauma obtunded patient. Cervical spine immobilization - remove anterior collar while c-spine c is immobilized. 10

11 LEMON Law L ook externally E xamine (3-3-2) M allampati grade O bstruction N eck mobility LEMON: Predictive? 156 ED patients requiring intubation Scored using LEMON Simple point system used (0 to 10) Compared to laryngoscopic view (Cormack Lehane) Felt to be predictive, P<0.05 Reed MJ et al. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J 2005 Feb; 22:

12 LEMON: Predictive? Reed MJ et al. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J 2005 Feb; 22: Airway alternatives Nasal Supraglottic: Infraglottic: ZIST BNTI Fiberoptics BVM Intubating LMA Lightwand Glidescope Fiberoptics Bougie Combitube King-LT TTJV Cricothyrotomy Zone of Increasing Sphincter Tone 12

13 Rescue Devices Combitube Most require oral access Most are designed to deal with high anterior cords I-LMA, King-LT, Combitube Intubating stylet (bougie, frova,, etc.) Video - glidescope King-LT I-LMA 13

14 Video Laryngoscopy LMA CTrach Glidescope 14

15 Pediatric Asthmatic Preoxygenation: Desaturation Beginning to fatigue Sats dropping Needs to be intubated 6 ml/kg/min 3.4 ml/kg/min From: Benumof JL: Anesthesiology 87: , Preoxygenation: Desaturation 15

16 Awake look/scopes Antisyalogogue atropine or glycopyrrolate Anesthesia lidocaine (2-4%), benzocaine Decongestant oxymetazoline (afrin) Nebulize,, atomize (MADgic ), viscous Sedation ketamine,, versed Agitated Burn Case 42-year-old woman set herself on fire in her car. Uncooperative, yelling let me die % burns, mostly 3, 3, to face, trunk, anterior arms and thighs. Unable to get a BP or O2 sat. 16

17 Intubating Stylet/Bougie Clinical Issues: Agitated Patient Assessment of the difficult airway beware ego, fear, urgency The agitated or violent trauma patient Haldol, Droperidol, Midazolam, Ketamine 5 yo girl, choked on peanuts last night Unable to sleep, trouble breathing Looks tired, resp distress, tripod Oh, nuts 17

18 Airway alternatives Nasal Supraglottic: Infraglottic: ZIST BNTI Fiberoptics BVM Intubating LMA Lightwand Glidescope Fiberoptics Bougie Combitube King-LT TTJV Cricothyrotomy Zone of Increasing Sphincter Tone 18

19 No landmarks? Cricothyroid membrane under the 4 th finger The tongue is your friend find it and follow it to the glottis Suction,, suction, suction 4-finger rule for the cricothyroid membrane 19

20 Consider surgical airway early Summary Organized, rapid, simple approach Assess for difficult ventilation BONES Assess for difficult intubation LEMON 20

21 Obese asthmatic 21

Perioperative Airway Management:

Perioperative Airway Management: Perioperative Airway Management: Update on Tools and Techniques Toni Felberg, M.D., FAAP Assistant Professor of Anesthesiology and Pediatrics Baylor College of Medicine Texas Children s Hospital Houston,

More information

AIRWAY MANAGEMENT. Angkana Lurngnateetape, MD. Department of Anesthesiology Siriraj Hospital

AIRWAY MANAGEMENT. Angkana Lurngnateetape, MD. Department of Anesthesiology Siriraj Hospital AIRWAY MANAGEMENT Angkana Lurngnateetape, MD. Department of Anesthesiology Siriraj Hospital Perhaps the most important responsibility of the anesthesiologist is management of the patient s airway Miller

More information

AIRWAY MANAGEMENT IN THE CRITICALLY ILL. Robert J. Vissers MD High Risk Emergency Medicine Hawaii, 2012

AIRWAY MANAGEMENT IN THE CRITICALLY ILL. Robert J. Vissers MD High Risk Emergency Medicine Hawaii, 2012 AIRWAY MANAGEMENT IN THE CRITICALLY ILL Robert J. Vissers MD High Risk Emergency Medicine Hawaii, 2012 Objectives Review the optimal airway management for the crashing patient in the ED Prevent the complications

More information

Trauma Airway Management: Myths & Pearls

Trauma Airway Management: Myths & Pearls Trauma Airway Management: Myths & Pearls Past Present and Future G Kovacs MD MHPE FRCPC Professor, Department of Emergency Medicine & Anesthesiology Dalhousie University Halifax, NS Speaker Disclosure

More information

Difficult Airway. Predicting Difficult Mask Ventilation

Difficult Airway. Predicting Difficult Mask Ventilation Predicting Difficult Mask Ventilation Difficult mask ventilation can be a serious threat to a patient if difficult intubation occurs, and the patient cannot be properly ventilated by mask Five factors

More information

Continued on next page

Continued on next page Resident Journal Review An Update on Airway Management in Emergency Medicine Authors: Michael Allison, MD; Michael Scott, MD; Kami Hu, MD; David Bostick, MD; Daniel Boutsikaris, MD Edited by: Michael C.

More information

Airway assessment. Bran Retnasingham Andy McKechnie

Airway assessment. Bran Retnasingham Andy McKechnie Airway assessment Bran Retnasingham Andy McKechnie The average Camberwell patient? Airway assessment There is one skill above all else that an anaesthetist is expected to exhibit and that is to

More information

Acute Respiratory Failure

Acute Respiratory Failure Acute Respiratory Failure Family Medicine Update Big Sky, Montana January, 2014 Mark Tieszen, MD, FCCM, FCCP Sanford Medical Center Fargo Critical Care Medicine mark.tieszen@sanfordhealth.org Acute Respiratory

More information

Rapid Sequence Intubation in Pre-Hospital Care

Rapid Sequence Intubation in Pre-Hospital Care Rapid Sequence Intubation in Pre-Hospital Care Dr Adam Chesters Specialist Registrar in Emergency Medicine and Pre-Hospital Care London s Air Ambulance CV University of Leicester Medical School Emergency

More information

setting.

setting. 2.1 ANCC CONTACT HOURS By Linda Heltemes, CRNA, MS W While airway management is routinely performed in the surgical setting, it s never taken lightly. For patients with a difficult airway, the end result

More information

Airway Management. Rapid Sequence Intubation (RSI) P-Plan B

Airway Management. Rapid Sequence Intubation (RSI) P-Plan B Airway Management Rapid Sequence Intubation (RSI) RSI is the currently accepted method of quickly obtaining optimal intubating conditions. It is the delivery of an induction agent (to induce unconsciousness)

More information

AEROSPACE MEDICAL SERVICE SPECIALTY INDEPENDENT DUTY MEDICAL TECHNICIAN EMERGENCY MEDICINE PROCEDURES

AEROSPACE MEDICAL SERVICE SPECIALTY INDEPENDENT DUTY MEDICAL TECHNICIAN EMERGENCY MEDICINE PROCEDURES QTP4N0X1C-9 02 July 2015 AEROSPACE MEDICAL SERVICE SPECIALTY INDEPENDENT DUTY MEDICAL TECHNICIAN EMERGENCY MEDICINE PROCEDURES Volume 9 TOTAL FORCE, TOTAL CARE EVERYTIME, ANYWHERE 383d TRAINING SQUADRON/XUFB

More information

advanced airway management for the emergency physician

advanced airway management for the emergency physician 1 advanced airway management for the emergency physician june 9, 2010 reuben j. strayer mount sinai school of medicine objectives Discuss the common cognitive mistakes made in airway management Discuss

More information

Laryngeal Mask Airways (LMA), Indications and Use for the Pre-Hospital Provider. www.umke.org

Laryngeal Mask Airways (LMA), Indications and Use for the Pre-Hospital Provider. www.umke.org Laryngeal Mask Airways (LMA), Indications and Use for the Pre-Hospital Provider Objectives: Identify the indications, contraindications and side effects of LMA use. Identify the equipment necessary for

More information

PHSW Procedural Sedation Post-Test Answer Key. For the following questions, circle the letter of the correct answer(s) or the word true or false.

PHSW Procedural Sedation Post-Test Answer Key. For the following questions, circle the letter of the correct answer(s) or the word true or false. PHSW Procedural Sedation Post-Test Answer Key 1 1. Define Procedural (Conscious) Sedation: A medically controlled state of depressed consciousness where the patient retains the ability to continuously

More information

LMAs: Airway Management and Inhalant Anesthetics

LMAs: Airway Management and Inhalant Anesthetics LMAs: Airway Management and Inhalant Anesthetics Wanda O.Wilson, PhD, CRNA University of Cincinnati College of Nursing Nurse Anesthesia Major Brain AIJ: The Laryngeal Mask A New Concept in Airway Management.

More information

What s New in Airway Management

What s New in Airway Management What s New in Airway Management Monday, Sept. 28th, 2015 Andreas Grabinsky, MD! Associate Professor, Department of Anesthesiology! Program Director and Section Head, Emergency & Trauma Anesthesia! Associate

More information

Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea

Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea Clinical Research Article Korean J Anesthesiol 2010 November 59(5): 314-318 DOI: 10.4097/kjae.2010.59.5.314 Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes

More information

Decision Making in Airway Management. Indications and Selection of Patients for Awake Intubation*

Decision Making in Airway Management. Indications and Selection of Patients for Awake Intubation* CHOOSE CONFIDENCE Decision Making in Airway Management Indications and Selection of Patients for Awake Intubation* William Rosenblatt, M.D. The induction of anesthesia, including the onset of apnea, takes

More information

Neonatal Intubation. Purpose. Scope. Indications. Equipment Cardiorespiratory monitor SaO 2 monitor. Anatomic Considerations.

Neonatal Intubation. Purpose. Scope. Indications. Equipment Cardiorespiratory monitor SaO 2 monitor. Anatomic Considerations. Page 1 of 5 Purpose Scope Indications Neonatal Intubation To assure proper placement of endotracheal tubes for maximum ventilation using proper intubation procedures. The policy applies to all Respiratory

More information

PRACTICE Guidelines are systematically developed

PRACTICE Guidelines are systematically developed Copyright by the American Society of Anesthesiologists. Unauthorized reproduction of this article is prohibited. Special Articles Practice Guidelines for Management

More information

EMS Course Requirements

EMS Course Requirements EMS Course Requirements The following outlines should be followed when creating your course syllabi. The minimum course hours must be met, but they can be exceeded depending on the needs of your class.

More information

Rotation Specific Guidelines CCFP - EM Residency Program

Rotation Specific Guidelines CCFP - EM Residency Program Rotation Specific Guidelines CCFP - EM Residency Program ANAESTHESIA To utilize the relevant competencies contained within the CanMEDS-FM roles to develop anesthesia skills relevant to the emergency physician

More information

GWAS Competency Mapping Levels of Medical Support Within GWAS

GWAS Competency Mapping Levels of Medical Support Within GWAS GWAS Competency Mapping Levels of Medical Support Within GWAS Great Western Ambulance Service NHS Trust is pleased to be able to work with a range of doctors in delivering effective pre-hospital care.

More information

Original Contributions

Original Contributions doi:10.1016/j.jemermed.2011.05.019 The Journal of Emergency Medicine, Vol. -, No. -, pp. 1 6, 2011 Copyright Ó 2011 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter

More information

Airway Management. J. D Urbano. For the Respiratory Therapist. Because at the Head of Every Team is a Respiratory Therapist

Airway Management. J. D Urbano. For the Respiratory Therapist. Because at the Head of Every Team is a Respiratory Therapist Airway Management For the Respiratory Therapist J. D Urbano Respiratory Therapists are highly trained and specialized members of the allied healthcare arsenal. They deal directly with patients who suffer

More information

ENT Emergencies. Injuries of the Neck. Registrar Dept Trauma and emergency Medicine Tygerberg Hospital

ENT Emergencies. Injuries of the Neck. Registrar Dept Trauma and emergency Medicine Tygerberg Hospital ENT Emergencies Injuries of the Neck Registrar Dept Trauma and emergency Medicine Tygerberg Hospital Neck Injuries Blunt and Penetrating Trauma Blunt Injuries Blunt trauma direct/indirect Trauma to larynx

More information

Geisinger Health System Anesthesiology Residency Program. Advanced Airway Management

Geisinger Health System Anesthesiology Residency Program. Advanced Airway Management Geisinger Health System Anesthesiology Residency Program Advanced Airway Management INTRODUCTION Airway management is part of everyday anesthesia practice. Major complications are frequently associated

More information

First Responder: The National EMS Scope of Practice changes the name to Emergency Medical Responder.

First Responder: The National EMS Scope of Practice changes the name to Emergency Medical Responder. APPROVED SCOPE 2/8/08 BOARD MTG First Responder: The National EMS Scope of Practice changes the name to Emergency Medical Responder. Emergency Medical Responder (EMR) Description of the Profession The

More information

UC Davis Medical Center Emergency Medicine Airway Equipment: Contents, Cleaning and Stocking

UC Davis Medical Center Emergency Medicine Airway Equipment: Contents, Cleaning and Stocking UC Davis Medical Center Emergency Medicine Airway Equipment: Contents, Cleaning and Stocking Introduction: Due to the large volume of critically ill patients who present for care at the U.C. Davis Emergency

More information

Airway Management. J. D Urbano. For the Respiratory Therapist. Because at the Head of Every Team is a Respiratory Therapist

Airway Management. J. D Urbano. For the Respiratory Therapist. Because at the Head of Every Team is a Respiratory Therapist Airway Management For the Respiratory Therapist J. D Urbano Respiratory Therapists are highly trained and specialized members of the allied healthcare arsenal. They deal directly with patients who suffer

More information

Rapid Sequence Intubation A Guide for Assistants

Rapid Sequence Intubation A Guide for Assistants Rapid Sequence Intubation A Guide for Assistants Working outwith the theatre setting Contents Course Aim...1 Course Objectives...1 Basic Airway Care and Oxygenation...2 Rapid Sequence Intubation...2 Definition...2

More information

Coventry Airway Management course

Coventry Airway Management course Airway workshops The workshops are based on DAS Guidelines for managing un-anticipated difficult intubation. In addition lung isolation techniques workshop is recently introduced to this course. The aim

More information

Conundrums in Ambulatory Anesthesia I

Conundrums in Ambulatory Anesthesia I THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER DALLAS Parkland Hospital, Dallas, Texas Conundrums in Ambulatory Anesthesia I Girish P. Joshi, MBBS, MD, FFARCSI Professor of Anesthesiology and Pain

More information

Version 7 Related Documents Monitoring; Handover; Emergency Anaesthesia Alasdair Corfield

Version 7 Related Documents Monitoring; Handover; Emergency Anaesthesia Alasdair Corfield Emergency Medical Retrieval Service (EMRS) www.emrs.scot.nhs.uk Standard Operating Procedure Public Distribution Title Patient Documentation Version 7 Related Documents Monitoring; Handover; Emergency

More information

Kids, Cars, Falls and Brawls The Pediatric Golden Hour. Kids, Cars, Falls and Brawls The Pediatric Golden Hour. The Pediatric Golden Hour

Kids, Cars, Falls and Brawls The Pediatric Golden Hour. Kids, Cars, Falls and Brawls The Pediatric Golden Hour. The Pediatric Golden Hour Kids, Cars, Falls and Brawls Kids, Cars, Falls and Brawls M. Jeffrey Fein RN, CFRN Educator Critical Care Transport Team The Golden Hour The idea has been propagated from intuition and the writings of

More information

Patient Care Services Policy & Procedure Title: No. 8720-0059

Patient Care Services Policy & Procedure Title: No. 8720-0059 Page: 1 of 8 I. SCOPE: This policy applies to Saint Francis Hospital, its employees, medical staff, contractors, patients and visitors regardless of service location or category of patient. This policy

More information

Proposed procedure: Insertion of the LMA Supreme for airway management by flight paramedics.

Proposed procedure: Insertion of the LMA Supreme for airway management by flight paramedics. Request for approval of a trial study This document follows Form #EMSA-0391 EMS Medical Director: Dr. Mark Luoto Local EMS Agency: Coastal Valleys EMS Agency Proposed procedure: Insertion of the LMA Supreme

More information

Airway and Breathing Skills Levels Interpretive Guidelines

Airway and Breathing Skills Levels Interpretive Guidelines Office of Emergency Medical Services and Trauma INDEX EFFECTIVE LAST REVIEW PAGES VERSION R-P11A 7/1/2011 7/1/2011 5 2011 Scope of Practice for EMS Personnel Emergency Medical Personnel are permitted to

More information

Patient Assessment/Management Trauma

Patient Assessment/Management Trauma Patient Assessment/Management Trauma Date: / / Test Site Location: Station #: Takes or verbalizes standard precautions (BSI) if appropriate based on patient scenario SCENE SIZE-UP Determines the scene

More information

Pediatric Airway Management

Pediatric Airway Management Pediatric Airway Management Dec 2003 Dr. Shapiro I., PICU Adult Chain of Survival EMS CPR ALS Early Defibrillation Pediatric Chain of Survival Prevention CPR EMS ALS Out-of-Hospital Cardiac Arrest SIDS

More information

Difficult Pre-hospital Airway Management

Difficult Pre-hospital Airway Management Difficult Pre-hospital Airway Management Frans L. Rutten, MD, FDSA Elisabeth Hospital Tilburg, The Netherlands In management of patients with an emergency, airway management and ventilatory care are the

More information

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Perioperative Management of Patients with Obstructive Sleep Apnea Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Disclosures. This activity is supported by an education grant from Trivalley

More information

Diagnosis and Treatment

Diagnosis and Treatment Sleep Apnea: Diagnosis and Treatment Sleep Apnea Sleep Apnea is Common Dangerous Easily recognized Treatable Types of Sleep Disordered Breathing Apnea Cessation of airflow > 10 seconds Hypopnea Decreased

More information

4,871 Emergency Airway Encounters by Air Medical Providers: A Report of the Air Transport Emergency Airway Management (NEAR VI: A-TEAM ) Project

4,871 Emergency Airway Encounters by Air Medical Providers: A Report of the Air Transport Emergency Airway Management (NEAR VI: A-TEAM ) Project 4,871 Emergency Airway Encounters by Air Medical Providers: A Report of the Air Transport Emergency Airway Management (NEAR VI: A-TEAM ) Project The Harvard community has made this article openly available.

More information

TOWN OF FAIRFIELD HEALTH DEPARTMENT PUBLIC HEALTH NURSING

TOWN OF FAIRFIELD HEALTH DEPARTMENT PUBLIC HEALTH NURSING TOWN OF FAIRFIELD HEALTH DEPARTMENT PUBLIC HEALTH NURSING PROGRAM: School Health APPROVED BY: Board of Health School Medical Advisor POLICY: With Portable Suction Machine DATE: March 14, 1994 POLICY DEFINITION:

More information

The induction of anesthesia for

The induction of anesthesia for Preoperative planning of airway management in critical care patients William H. Rosenblatt, MD Objective: The aim of this article is to review aspects of airway evaluation that may affect the care of the

More information

Module 5 ADULT RECOvERY POSITION STEP 1 POSITION ThE victim

Module 5 ADULT RECOvERY POSITION STEP 1 POSITION ThE victim Module 5 ADULT RECOVERY POSITION The recovery position is used in the management of victims who are unresponsive but have breathing and pulse. When an unresponsive victim is lying supine, the airway may

More information

Pain Management in the Critically ill Patient

Pain Management in the Critically ill Patient Pain Management in the Critically ill Patient Jim Ducharme MD CM, FRCP President-Elect, IFEM Clinical Professor of Medicine, McMaster University Adjunct Professor of Family Medicine, Queens University

More information

Underwriting Sleep Apnea

Underwriting Sleep Apnea Underwriting Sleep Apnea Joel Weiner, MD, FLMI April 29, 2014 WAHLU The Northwestern Mutual Life Insurance Company Milwaukee, WI A Brief Survey Before We Get Started The Weiner Sleepiness Scale How likely

More information

AIRWAY Airway MANAGEMENT

AIRWAY Airway MANAGEMENT SEPTEMBER 19TH - 20TH 2015 STANFORD Stanford ADVANCED Advanced AIRWAY Airway MANAGEMENT Management AND and FIBEROPTIC Fiberoptic COURSE Course Li Ka Shing Center for Learning and Knowledge Stanford, California

More information

The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:

The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material: Airway Management, Respiration and Artificial Ventilation EMR Applies knowledge (fundamental depth, foundational breadth) of general anatomy and physiology to assure a patent airway, adequate mechanical

More information

An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach )

An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach ) An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach ) A 2-Year Prospective Validation in Patients for Elective Abdominal, Gynecologic, and

More information

Evaluation of the GlideScope Ò for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar

Evaluation of the GlideScope Ò for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar doi:10.1111/j.1365-2044.2009.06075.x Evaluation of the GlideScope Ò for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar I. Bathory, 1 P. Frascarolo, 2 C. Kern

More information

An Evaluation of the Rapid Airway Management Positioner in Obese Patients Undergoing Gastric Bypass or Laparoscopic Gastric Banding Surgery

An Evaluation of the Rapid Airway Management Positioner in Obese Patients Undergoing Gastric Bypass or Laparoscopic Gastric Banding Surgery OBES SURG (2010) 20:1436 1441 DOI 10.1007/s11695-009-9885-8 CASE REPORT An Evaluation of the Rapid Airway Management Positioner in Obese Patients Undergoing Gastric Bypass or Laparoscopic Gastric Banding

More information

National Registry of Emergency Medical Technicians Emergency Medical Technician Psychomotor Examination BLEEDING CONTROL/SHOCK MANAGEMENT

National Registry of Emergency Medical Technicians Emergency Medical Technician Psychomotor Examination BLEEDING CONTROL/SHOCK MANAGEMENT BLEEDING CONTROL/SHOCK MANAGEMENT Candidate: Examiner: Date: Signature: Possible Applies direct pressure to the wound 1 NOTE: The examiner must now inform the candidate that the wound continues to bleed.

More information

Sign up to receive ATOTW weekly -

Sign up to receive ATOTW weekly - THE DIFFICULT PAEDIATRIC AIRWAY ANAESTHESIA TUTORIAL OF THE WEEK 250 13 TH FEBRUARY 2012 Dr Yosha Prasad SpR Anaesthesia Lister Hospital, Stevenage, UK Yosha@doctors.org.uk QUESTIONS Before continuing,

More information

National Registry of Emergency Medical Technicians Emergency Medical Responder Psychomotor Examination PATIENT ASSESSMENT/MANAGEMENT TRAUMA

National Registry of Emergency Medical Technicians Emergency Medical Responder Psychomotor Examination PATIENT ASSESSMENT/MANAGEMENT TRAUMA PATIENT ASSESSMENT/MANAGEMENT TRAUMA Scenario # Note: Areas denoted by ** may be integrated within sequence of Primary Survey/Resuscitation SCENE SIZE-UP Determines the mechanism of injury/nature of illness

More information

Patient positioning is an important

Patient positioning is an important PRINTER-FRIENDLY VERSION AT ANESTHESIOLOGYNEWS.COM Airway Management and Patient Positioning: A Clinical Perspective DAVIDE CATTANO, MD, PHD Assistant Professor, Medical Director of Anesthesia Clinic Department

More information

Diseases and Health Conditions that can Lead to Daytime Sleepiness

Diseases and Health Conditions that can Lead to Daytime Sleepiness October 21, 2014 Diseases and Health Conditions that can Lead to Daytime Sleepiness Indira Gurubhagavatula, MD, MPH Associate Professor Director, Occupational Sleep Medicine University of Pennsylvania,

More information

Six anesthesiologists from around

Six anesthesiologists from around PRINTER-FRIENDLY VERSION AVAILABLE AT ANESTHESIOLOGYNEWS.COM Airway Management Roundtable: Seven Questions Six anesthesiologists from around the world were asked to answer 7 questions, whose general theme

More information

Community Ambulance Service of Minot ALS Standing Orders Legend

Community Ambulance Service of Minot ALS Standing Orders Legend Legend Indicates General Information and Guidelines Indicates Procedures Indicates Medication Administration Indicates Referral to Other Protocol Indicates Referral to Online Medical Direction Pediatric

More information

State of New Hampshire Department of Safety Division of Fire Standards and Training & Emergency Medical Services

State of New Hampshire Department of Safety Division of Fire Standards and Training & Emergency Medical Services State of New Hampshire Department of Safety Division of Fire Standards and Training & Emergency Medical Services September 2013 PATIENT ASSESSMENT / MANAGEMENT - TRAUMA Time allowed: 10 minutes SCENARIO

More information

Medical Coverage Policy Monitored Anesthesia Care (MAC)

Medical Coverage Policy Monitored Anesthesia Care (MAC) Medical Coverage Policy Monitored Anesthesia Care (MAC) Device/Equipment Drug Medical Surgery Test Other Effective Date: 9/1/2004 Policy Last Updated: 1/8/2013 Prospective review is recommended/required.

More information

The American Society of Anesthesiologists (ASA) has defined MAC as:

The American Society of Anesthesiologists (ASA) has defined MAC as: Medical Coverage Policy Monitored Anesthesia Care (MAC) sad EFFECTIVE DATE: 09 01 2004 POLICY LAST UPDATED: 11 04 2014 OVERVIEW The intent of this policy is to address anesthesia services for diagnostic

More information

AEC: INTERMEDIATE to PARAMEDIC PROGRAM MONDAY/WEDNESDAY @ AEC TRAINING CENTER OCTOBER 22, 2015 through JULY 23, 2016

AEC: INTERMEDIATE to PARAMEDIC PROGRAM MONDAY/WEDNESDAY @ AEC TRAINING CENTER OCTOBER 22, 2015 through JULY 23, 2016 AEC: INTERMEDIATE to PARAMEDIC PROGRAM MONDAY/WEDNESDAY @ AEC TRAINING CENTER OCTOBER 22, 2015 through JULY 23, 2016 Thursday 10/22/15 9a-4p 10/24/15 Orientation/Introduction Ground Ambulance Operations

More information

AWAKE FIBREOPTIC INTUBATION THE BASICS ANAESTHESIA TUTORIAL OF THE WEEK 201

AWAKE FIBREOPTIC INTUBATION THE BASICS ANAESTHESIA TUTORIAL OF THE WEEK 201 AWAKE FIBREOPTIC INTUBATION THE BASICS ANAESTHESIA TUTORIAL OF THE WEEK 201 18 TH OCTOBER 2010 Dr S Kritzinger Registrar in Anaesthetics Pinderfields General Hospital, Wakefield, UK Dr M van Greunen Consultant

More information

Virginia Office of Emergency Medical Services Scope of Practice - Procedures for EMS Personnel

Virginia Office of Emergency Medical Services Scope of Practice - Procedures for EMS Personnel Specific tasks in this document shall refer to the Virginia Education Standards. AIRWAY TECHNIQUES Airway Adjuncts Airway Maneuvers Alternate Airway Devices Cricothyrotomy Obstructed Airway Clearance Intubation

More information

PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice

PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice PROCEDURAL SEDATION/ANALGESIA NCBON Position Statement for RN Practice P.O. BOX 2129 Raleigh, NC 27602 (919) 782-3211 FAX (919) 781-9461 Nurse Aide II Registry (919) 782-7499 www.ncbon.com Issue: Administration

More information

Administrative Policy and Procedure Policy Number: 300.005

Administrative Policy and Procedure Policy Number: 300.005 Administrative Policy and Procedure Policy Number: 300.005 Subject: Sedation Page: 1 of 7 Effective: March 3, 1997 Revised: September 18, 2009 Approved: Signed by Kathy Guyette, VP and Chief Nursing Offcier

More information

Northwestern Health Sciences University. Basic Life Support for Healthcare Providers

Northwestern Health Sciences University. Basic Life Support for Healthcare Providers Northwestern Health Sciences University Basic Life Support for Healthcare Providers Pretest May 2005 This examination to be used only as a PRECOURSE TEST for BLS for Healthcare Providers Courses Based

More information

Enables MDA Medical Teams to categorize victims in mass casualty scenarios, in order to be able to triage and treat casualties

Enables MDA Medical Teams to categorize victims in mass casualty scenarios, in order to be able to triage and treat casualties MDA Disposable ALS + BLS Medical Ambulance Equipment Prices shown in CDN. Funds Items Description Picture Mass Casualty ID tag 1000 units = $350 Enables MDA Medical Teams to categorize victims in mass

More information

MicroTextbook of Airway Management D. John Doyle MD PhD FRCPC Revision 2.0 April /28. Introduction. Acknowledgements / Peer Review

MicroTextbook of Airway Management D. John Doyle MD PhD FRCPC Revision 2.0 April /28. Introduction. Acknowledgements / Peer Review MicroTextbook of Airway Management D. John Doyle MD PhD FRCPC Revision 2.0 April 2006 1/28 Introduction This work is intended as an introductory synopsis for medical students and junior residents. Copies

More information

EMERGENCY MEDICAL RESPONDER (EMR) PRACTICAL SKILLS EXAMINATION REPORT State Form 54407 (R / 5-13)

EMERGENCY MEDICAL RESPONDER (EMR) PRACTICAL SKILLS EXAMINATION REPORT State Form 54407 (R / 5-13) EMERGENCY MEDICAL RESPONDER (EMR) PRACTICAL SKILLS EXAMINATION REPT State Form 54407 (R / 5-3) INDIANA DEPARTMENT OF HOMELAND SECURITY EMERGENCY MEDICAL SERVICES CERTIFICATION 302 West Washington Street,

More information

AIRWAY ASSESSMENT : PREDICTORS OF DIFFICULT AIRWAY

AIRWAY ASSESSMENT : PREDICTORS OF DIFFICULT AIRWAY GUPTA, Indian J. Anaesth. SHARMA, 2005; JAIN 49 : (4) AIRWAY : 257-262 ASSESSMENT PREDICTORS OF DIFFICULT AIRWAY 257 AIRWAY ASSESSMENT : PREDICTORS OF DIFFICULT AIRWAY Dr. Sunanda Gupta 1 Dr. Rajesh Sharma

More information

MODEL SEDATION PROTOCOL FOR MODERATE SEDATION AND ANALGESIA PERFORMED BY NON-ANESTHESIA PROVIDERS DURING PROCEDURES

MODEL SEDATION PROTOCOL FOR MODERATE SEDATION AND ANALGESIA PERFORMED BY NON-ANESTHESIA PROVIDERS DURING PROCEDURES MODEL SEDATION PROTOCOL FOR MODERATE SEDATION AND ANALGESIA PERFORMED BY NON-ANESTHESIA PROVIDERS DURING PROCEDURES ON ADULTS AND CHILDREN OLDER THAN 10 YEARS OF AGE. PURPOSE This policy has been established

More information

Degree of Intervention

Degree of Intervention Inglewood Care Centre Degree of Intervention Handbook for Residents and Families Index Introduction..................................................... 2 Beliefs, Values, and Wishes.........................................

More information

Airway Management Apnea or Obstruction?

Airway Management Apnea or Obstruction? Airway Management Apnea or Obstruction? Florida Dental Society of Anesthesiology February 2016 H. William Gottschalk, D.D.S. Fellow, Academy of General Dentistry Fellow, American Dental Society of Anesthesiology

More information

The first priority in the care of all trauma patients is the

The first priority in the care of all trauma patients is the GUIDELINE Emergency tracheal intubation immediately following traumatic injury: An Eastern Association for the Surgery of Trauma practice management guideline Julie Mayglothling, MD, Therese M. Duane,

More information

One Lung Ventilation Module (OLV)

One Lung Ventilation Module (OLV) 1 One Lung Ventilation Module (OLV) A Thoracic Surgery Directors Association (TSDA) Cardiothoracic Surgery Resident Boot Camp Syllabus The ability to isolate one of the lungs is an essential skill set

More information

Miller, CG: Management of the Difficult Intubation in Closed Malpractice Claims. ASA Newsletter 64(6):13-16 & 19, 2000.

Miller, CG: Management of the Difficult Intubation in Closed Malpractice Claims. ASA Newsletter 64(6):13-16 & 19, 2000. Citation Miller, CG: Management of the Difficult Intubation in Closed Malpractice Claims. ASA Newsletter 64(6):13-16 & 19, 2000. Full Text In order to assess and minimize adverse outcomes related to airway

More information

2012 Mississippi EMT Transitional Refresher Curriculum EMT Refresher Training- Curriculum Transition: EMT-Basic EMT Timeline: February 2012-March 2015

2012 Mississippi EMT Transitional Refresher Curriculum EMT Refresher Training- Curriculum Transition: EMT-Basic EMT Timeline: February 2012-March 2015 2012 Mississippi EMT Transitional Refresher Curriculum EMT Refresher Training- Curriculum Transition: EMT-Basic EMT Timeline: February 2012-March 2015 Introduction This document provides the statewide

More information

Scenario 2 Is it ever safe enough?

Scenario 2 Is it ever safe enough? IRECA BLS Competition 2011 Scenario 2 Is it ever safe enough? Team Name Captain Name Judge 1 Judge 2 The Event: You are dispatched to a shooting for two injured at a local bar. Witnesses have told police

More information

Pediatric Difficult Airway Management: New Modalities. Paul Stricker, MD University of Pennsylvania School of Medicine

Pediatric Difficult Airway Management: New Modalities. Paul Stricker, MD University of Pennsylvania School of Medicine Pediatric Difficult Airway Management: New Modalities Paul Stricker, MD Children s Hospital of Philadelphia University of Pennsylvania School of Medicine Goals Review pediatric anatomy and physiology as

More information

Emergency Medical Services Advanced Level Competency Checklist

Emergency Medical Services Advanced Level Competency Checklist Emergency Services Advanced Level Competency Checklist EMS Service: Current License in State of Nebraska: # (Copy of license kept in file at station) Date of joining EMS Service: EMS Service Member Name:

More information

Ground Vehicle Supply Requirements for EMR Quick Response Units.

Ground Vehicle Supply Requirements for EMR Quick Response Units. Ground Vehicle Supply Requirements for EMR Quick Response Units. Ring cutters 2 Blood pressure cuffs, one adult, one pediatric 2 Stethoscopes, one adult and one pediatric or combination 2 Heavy duty shears

More information

Many newer supraglottic airways such as the LMA ProSeal. What s New in Supraglottic Airways? Three Decades of Evolution to Tract Separation

Many newer supraglottic airways such as the LMA ProSeal. What s New in Supraglottic Airways? Three Decades of Evolution to Tract Separation PRINTER-FRIENDLY VERSION AT ANESTHESIOLOGYNEWS.COM What s New in Supraglottic Airways? Three Decades of Evolution to Tract Separation DARWIN C. VIERNES, MD Acting Instructor and Senior Fellow Department

More information

Changes in the Evaluation and Treatment of Sleep Apnea

Changes in the Evaluation and Treatment of Sleep Apnea Changes in the Evaluation and Treatment of Sleep Apnea Joseph DellaValla, MD FACP Medical Director Center for Sleep Medicine At Androscoggin Valley Hospital Sleep Related Breathing Problems Obstructive

More information

American Heart Association. BLS Instructor Course. Written Examination. July 2003

American Heart Association. BLS Instructor Course. Written Examination. July 2003 American Heart Association BLS Instructor Course Written Examination July 2003 Basic Life Support Instructor Exam Part I Please do not mark on this examination. Record the best answer on the separate answer

More information

Two Hundred Sixty Pediatric Emergency Airway Encounters by Air Transport Personnel

Two Hundred Sixty Pediatric Emergency Airway Encounters by Air Transport Personnel ORIGINAL ARTICLE Two Hundred Sixty Pediatric Emergency Airway Encounters by Air Transport Personnel A Report of the Air Transport Emergency Airway Management (NEAR VI: A-TEAM ) Project William Wallace

More information

CITY OF HOUSTON Department of Health and Human Services Emergency Medical Services Program

CITY OF HOUSTON Department of Health and Human Services Emergency Medical Services Program Ambulance Service Permit Application Process New Applicants: Please read and complete the following application carefully. Make sure all information is accurate to prevent a delay in verification and processing.

More information

CITY OF HOUSTON Department of Health and Human Services Emergency Medical Services Program

CITY OF HOUSTON Department of Health and Human Services Emergency Medical Services Program Ambulance Service Permit Application Process New Applicants: Please read and complete the following application carefully. Make sure all information is accurate to prevent a delay in verification and processing.

More information

THE AIRWAY IN AEROMEDICAL EVACUATION. PBLD (Problem Based Learning Discussion)

THE AIRWAY IN AEROMEDICAL EVACUATION. PBLD (Problem Based Learning Discussion) THE AIRWAY IN AEROMEDICAL EVACUATION PBLD (Problem Based Learning Discussion) D. John Doyle MD PhD 2012 Edition Image Credit: http://www.arabianaerospace.aero/media/images/stories/medevac%20services.jpg

More information

- Woody Kageler, M.D.

- Woody Kageler, M.D. Dear Parent/Guardian, We all want our children with asthma to be healthy! Asthma can be a frightening experience for kids, as well as their parents. Let Darby BoIngg be your partner, along with your physician,

More information

ROLE OF ORAL APPLIANCES TO TREAT OBSTRUCTIVE SLEEP APNEA

ROLE OF ORAL APPLIANCES TO TREAT OBSTRUCTIVE SLEEP APNEA 1 ROLE OF ORAL APPLIANCES TO TREAT OBSTRUCTIVE SLEEP APNEA There are three documented ways to treat obstructive sleep apnea: 1. CPAP device 2. Oral Appliances 3. Surgical correction of nasal and oral obstructions

More information

a guide to understanding pierre robin sequence

a guide to understanding pierre robin sequence a guide to understanding pierre robin sequence a publication of children s craniofacial association a guide to understanding pierre robin sequence this parent s guide to Pierre Robin Sequence is designed

More information

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder Post-Traumatic Stress Disorder It s natural to be afraid when you re in danger. It s natural to be upset when something bad happens to you or someone you know. But if you feel afraid and upset weeks or

More information

MODERATE SEDATION RECORD (formerly termed Conscious Sedation)

MODERATE SEDATION RECORD (formerly termed Conscious Sedation) (POLICY #DOC-051) Page 1 of 6 WELLSPAN HEALTH - YORK HOSPITAL NURSING POLICY AND PROCEDURE Dates: Original Issue: September 1998 Annual Review: March 2012 Revised: March 2010 Submitted by: Brenda Artz

More information

Sign up to receive ATOTW weekly - email worldanaesthesia@mac.com

Sign up to receive ATOTW weekly - email worldanaesthesia@mac.com OBSTRUCTIVE SLEEP APNOEA AND ANAESTHESIA ANAESTHESIA TUTORIAL OF THE WEEK 152 21 ST SEPTEMBER 2009 Dr Shona Bright Royal Hobart Hospital Correspondence to shona.bright@dhhs.tas.gov.au QUESTIONS Before

More information