What s New in Airway Management

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1 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 Medical Director King County Medic One

2 Learning Objectives Importance of Airway Management! Trauma Airway Scenarios! Airway tools! Other things to consider!

3 Harborview Medical Center Level I Trauma Center (Washington State, Alaska, Idaho, Montana)! 25 Operating rooms - 14,000 surgeries/year! 69,000 ED visits - 18,000 admissions! 4120 Trauma admissions 697 patients directly to OR!

4 Harborview Medical Center University of Washington

5

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7 Prehospital Airway Management

8 Learning Objectives Importance of Airway Management! Trauma Airway Scenarios! Airway tools! Other things to consider!

9 Miraflor E. et al. Timing is Everything: Delayed Intubation is Associated with Increased Mortality in Initially Stable Trauma Patients. J surg. research 2011.

10 Miraflor E. et al. Timing is Everything: Delayed Intubation is Associated with Increased Mortality in Initially Stable Trauma Patients. J surg. research 2011.

11 Bernard SA et al. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury. Annals of Surgery 2010; 252(6):

12 Victoria, Australia Results: A total of 312 patients with severe TBI were randomly assigned to paramedic rapid sequence intubation or hospital intubation. The success rate for paramedic intubation was 97%....The proportion of patients with favorable outcome... was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) Bernard SA et al. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury. Annals of Surgery 2010; 252(6):

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14 The overall [intubation] success rate was 100%; in 87.4% the first attempt was successful. Helm M, Hossfeld B, Schafer S, Hoitz J, Lampl L. Factors influencing emergency intubation in the pre-hospital setting. A multicenter study in German Helicopter Emergency Medical Service. Br J Anaesth 2006;96:67 71

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16 Non-anaesthetists performed 4394 intubations and failed to intubate in 41 cases (0.9%); anaesthetists performed 2587 intubations and failed in 11 (0.4%) Lockey D, Crewdson K, Weaver A, Davies G. Observational study of the success rate of intubation and failed intubations of trauma patients by pre-hospital physicians. British Journal of Anaesthesia 2014; 113(2):220-5

17 RSI with direct Laryngoscopy 99.2% to 99.7% success rate.! Remaining patients underwent cricothyrotomy. Sollid SJ, Lossius HM, Søreide E. Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service. Scand J Trauma Resusc Emerg Med 2010;18:30!! Stephens CT, Kahntroff S, Dutton RP. The success of emergency endotracheal intubation in trauma patients: a 10-year experience at a major adult trauma referral center. Anesth Analg 2009;109:866 72!! Lockey D, Crewdson K, Weaver A, Davies G. Observational study of the success rate of intubation and failed intubations of trauma patients by pre-hospital physicians. British Journal of Anaesthesia 2014; 113(2):220-5!!

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20 Emergency Airway Management Who is managing the airway?

21 The person, with the highest level of training and the most experience available should supervise or perform a medical procedure. Dr. M. Copass

22 Learning Objectives! Importance of Airway Management! Trauma Airway Scenarios! Airway tools! Other things to consider!

23 Video Assisted Laryngoscopy

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25 Cricothyrotomy

26 Supraglottic Devices

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28

29

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31 Gum Elastic Bougie Eschmann!

32

33 Eschmann

34 Bag-Mask Ventilation

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39 Learning Objectives! Importance of Airway Management! Trauma Airway Scenarios! Airway tools! Other things to consider!

40 Injury to neck / face / airway

41 Difficult Airway Access

42 Cervical Spine Trauma!

43

44 Neerja B, Kajal J, Madhusudan R, Arup KM. Assessment of cervical spine movement during laryngoscopy with Macintosh and Truview laryngoscopes. J of Anesth Clin Pharmacology 2013;29(3):308-12

45 Learning Objectives Importance of Airway Management! Airway tools! Other things to consider!

46 Summary - Early Intubation and controlled ventilation! - Cervical Spine Protection! - Decompress stomach after intubation! - Low pressure/volume ventilation

47 Basic Considerations - Trauma patients are not NPO! - Always Pre-Oxygenate! - Hypotension is more dangerous than recall

48 System Change! - Manage (difficult) trauma intubations by/with Anesthesia! - Help with training of prehospital provider and Emergency physicians

49 What s New in Airway Management Andreas Grabinsky, MD! Associate Professor, Department of Anesthesiology! Program Director and Section Head, Emergency & Trauma Anesthesia! Associate Medical Director King County Medic One

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