Laryngeal mask airway: An alternative for the difficult airway
|
|
- Lorin Wilkinson
- 7 years ago
- Views:
Transcription
1 Laryngeal mask airway: An alternative for the difficult airway LCDR JEFFREY R. JONES, CRNA, BSN, BSNA, USN, NC Chesapeake, Virginia The laryngeal mask airway (LMA) was invented by Dr. Archie Brain at the London Hospital, Whitechapel, in Dr. Brain's main objective for the LMA was that it would provide a better method of maintaining a patient's airway than by face mask. Also, the LMA would be less hemodynamically stressful than with insertion of an endotracheal tube. The LMA consists of a silicone rubber tube connected to a miniature silicone mask. The perimeter of the mask consists of an inflatable elliptical cuff which forms a tip at the distal aspect of the LMA. The aperture bars in the dome of the mask lift the epiglottis away, so the lumen remains unobstructive. The LMA forms a low pressure seal around the larynx. The LMA is contraindicated in any situation where the patient is at risk for pulmonary aspiration. The LMA is not a substitute for a properly placed endotracheal tube in this situation. The American Society of Anesthesiologists'difficult airway algorithm recommends the insertion of an LMA when ventilation and/or intubation are difficult. The distal aperture of the LMA is in close approximation to the vocal cords, so a 6.0-mm internal diameter endotracheal tube can be passed over an intubating stylet or a pediatric fiberoptic bronchoscope to secure a patient's airway. Key words: Aspiration, difficult airway, laryngeal mask airway. Case presentation The patient was a 45-year-old female ASA physical status I scheduled to have a right brow lift under general endotracheal anesthesia. Assessment of her airway revealed a Mallampati class 1. All laboratory values were within normal limits with a hemoglobin of 13 g and a hematocrit of 49%. Upon arrival in the operating room, all routine monitors were applied. These included ECG, blood pressure cuff, pulse oximeter, precordial stethoscope, peripheral nerve stimulator, FiO 2 monitor, and end-tidal CO 2 monitor. This 55-kg patient was preoxygenated with 100% FiO 2 for 5 minutes. Curare, 3 mg, was given intravenously (IV), and then sufentanil, 20 ug, was slowly titrated for 2 minutes. Next, propofol, 2 mg/kg, was titrated for a total of 110 mg until loss of eyelid response. The patient was easily ventilated by mask. Succhylcholine, 1.5 mg/kg or 90 mg, was given IV. After loss of twitch demonstrated by the peripheral nerve stimulator, intubation was attempted with a Macintosh #3 blade. At this time, a small epiglottis was seen with no view of the vocal cords. This was a grade III laryngoscopic visualization. The patient's head was repositioned, and 444 Journal of the American Association of Nurse Anesthetists
2 intubation was attempted using a Miller #2 blade. The vocal cords were not visualized, but a 7.0-mm internal diameter endotracheal tube was inserted anteriorly to the epiglottis. The capnometer revealed no end-tidal CO2, and breath sounds were absent bilaterally. The endotracheal tube was removed. The patient was easily ventilated with FiO 2 100% and isoflurane 1.5%. Glycopyrolate.2 mg, propofol 60 mg, and succhylcholine, 40 mg, were given IV. At no time during attempts at intubation did the oxygen saturation drop below 97%. Vital signs remained stable during this time. An additional folded sheet was placed under the patient's head to facilitate optimal sniffing position for intubation. Cricoid pressure provided no benefit in our attempts to visualize the vocal cords with a Macintosh #3 or a Miller #2 blade. Next, a laryngeal mask airway size 3 was prepared for insertion by slightly overinflating the cuff with the prescribed volume of 20 ml and an additional 5 ml. No cuff leak was detected. After aspiration of the cuff, deflation was maintained by the one-way valve of the pilot tube. The cuff of the laryngeal mask airway (LMA) was everted by pressing the cuff against a firm surface during aspiration of air. Lubricant was applied to the dorsal tip. The patient's airway was opened, and the LMA was easily inserted. The capnometer showed CO 2 with each ventilation. Breath sounds were clear and equal bilaterally. The external surface of a 6.0-mm internal diameter endotracheal tube was lubricated and inserted over a pediatric 3-French gauge fiberoptic bronchoscope. The fiberoptic bronchoscope was inserted down the LMA, and the vocal cords were clearly visualized. While keeping the vocal cords in view with the fiberoptic scope, the endotracheal tube was passed over the fiberoptic scope and through the vocal cords. After inflating the endotracheal tube cuff, the LMA cuff was deflated. The LMA was left in place and surgery proceeded without incident. The patient was fully awake at the end of surgery. The LMA and the endotracheal tube were removed over the endotracheal tube changer. The endotracheal tube changer was removed as the patient maintained stable vital signs and an oxygen saturation of 97-99%. Laryngeal mask airway The LMA was invented by Dr. Archie Brain at the London Hospital, Whitechapel, in Dr. Brain's purpose was to have a device that established a more secure airway than is provided when controlling the airway with a face mask. The LMA is an alternative to maintaining the airway with a mask or having to intubate the airway.' 2 The LMA consists of a silicone rubber tube connected to a miniature silicone mask. The elliptical spoon-shaped mask has an inflatable cuff around its perimeter, which forms a tip at the distal aspect of the mask. The cuff is inflated using a pilot balloon similar to that of an endotracheal tube. The cuff volume is determined by the size of the LMA (Table I). The lumen of the mask has two aperture bars which lift the epiglottis away (Figure 1). No latex is used in the construction of the LMA. When the LMA is properly inserted, the tip of the LMA cuff is at the base of the hypopharynx against the upper esophageal sphincter. The sides of the LMA lie in the pyriform fossae, and the upper border of the mask lies at the base of the tongue, pushing it forward.- 3 Table I The laryngeal mask airway is available in four sizes with the appropriate cuff volume for each one. Size Patient's weight Cuff volume (ml) 1 Less than 6.5 kg to 25 kg to 70 kg Greater than 70 kg Figure 1 Anterior view of a size 4 laryngeal mask airway (LMA) A B C A - standard 15-mm proximal connector B - shaft of the LMA C - distal elliptical inflatable cuff D - aperture bars E - pilot balloon Preparation and insertion of LMA The LMA must first be checked for any leak by slightly overinflating the cuff with the prescribed volume and an additional 3-5 ml of air. Check the one-way valve of the pilot tube by deflating the cuff and verifying that deflation is main- D October 1995/ Vol. 63/No
3 tained. Inspect the aperture bars of the mask for damage. The cuff is deflated while firmly pressing Figure 3 it against a hard surface to evert the cuff walls. The dorsal tip of the laryngeal mask airway (LMA) is Lubricate the dorsal tip, making sure the concave pressed against the patient's hard palate, which makes side is free of lubricant. This prevents any lubri- sliding the LMA past the pharyngeal curvature easier. cant from dripping onto the vocal cords and causing larnygospasm during insertion. 1 2 Propofol, 2.5 mg/kg, as the induction agent has been shown in previous studies to cause less gagging, coughing, and additional dosing than thiopental. Depth of anesthesia must be adequate for insertion of a laryngeal airway but not the anesthetic depth associated with laryngeal intubation. 4 Propofol, 2.5 mg/kg, blocks the gag reflex when inserting the LMA after loss of eyelid response. LMA insertion causes no direct laryngeal i or tracheal stimulation, so the pressor response is of shorter duration compared to tracheal intubation. During insertion of the LMA, it is held with the index finger at the junction of the tube and mask. The index finger and thumb are positioned similar to that of holding a pen or pencil. The patient's neck is flexed and the head is extended Figure 2 Insertion of the laryngeal mask airway (LMA) 6L Snal (Figure 2). As you insert the LMA in the patient's mouth, press the dorsal tip of the LMA against the hard palate (Figure 3). This enables the LMA to slide past the curvature of the pharnyx. Inserting the LMA is one continuous motion until resistance Sis felt (Figure 4). This resistance signifies the LMA ^ is positioned in the triangular base of the hypopharnyx. Inflating the cuff with the prescribed vol- S/ ume of air (Table I) causes a slight retrograde S\movement of the LMA. After insertion, check for equal bilateral breath sounds and the presence of S" carbon dioxide on the end-tidal CO 2 monitor. On proper insertion of the LMA, a longitudiblack line of the shaft of the LMA is facing the patient's upper lip (Figure 5). Any deviation of this black line from being midline could indicate misplacement of the cuff and possible partial airway obstruction. The LMA is taped in place. A bite block is inserted to prevent biting and damage f ^to the LMA on emergence.- 3 ' 5. Advantages of the LMA The patient's neck is flexed and the head extended. Postoperative sore throat from the use of a With the other hand, hold the LMA with your thumb and f index finaer like a pencil. LMA was found to average 6.8%. Similar data col- I I lected from patients who underwent tracheal intu- 446 Journal of the American Association of Nurse Anesthetists
4 Figure 4 Insertion of the laryngeal mask airway (LMA) is one continuous motion until resistance is felt. Figure 5 Dorsal view of the laryngeal mask airway showing the longitudinal black line on the shaft, which faces the patient's upper lip The LMA is positioned in the triangular base of the hypopharynx. Properly placed, the distal aperture of the LMA is in front of the vocal cords. bation had a 28.6% incidence of postoperative sore throat." The LMA usually causes no trauma to the patient's lips, teeth, pharynx, or larynx. Patients anesthetized with the same agents had a mean blood pressure that was attenuated and of shorter duration when having an LMA inserted compared to the group having laryngoscopy and tracheal intubation. The diastolic pressure was 14.2% higher in the tracheal intubation group. 7 The pressor response from insertion of the LMA has a shorter duration than that from direct laryngoscopy and intubation. The LMA frees the anesthetist to administer drugs, monitor the patient, and maintain the anesthetic record. Insertion of the LMA is easily learned and demonstrated by medical and paramedical personnel. 8 Using the LMA reduces potential eye and facial nerve injury from prolonged use of a face mask and mask straps. The LMA provides a more secure and safer airway with fewer episodes of hypoxia detected by pulse oximetry in comparison to an airway maintained by a mask. A study of 64 patients showed oxygen desaturation of less than 95% occurred in 52% of patients with the airway maintained by mask alone compared to 13% for the LMA group. 9 The wide bore tube of the LMA provides minimal resistance for the spontaneously breathing patient.' Mechanical ventilation has been used with a gas leak occurring at 20 cm H 2 0 pressure.' 3 ' 5 Higher airway pressure during mechanical ventilation could cause gastric distention and potential aspiration. The LMA is removed when the patient's protective airway mechanisms have recovered, and the patient can open his or her mouth on command.' Contraindications and side effects of the LMA The LMA does not prevent pulmonary aspiration. Any patient with a history of gastroesophageal reflux, hiatal hernia, or any other condition that puts him or her at risk of aspiration or delayed gastric emptying such as obesity, pregnancy, and upper abdominal surgery, should avoid the routine use of an LMA. The LMA forms a low pressure seal around the larynx. The LMA should never be a substitute for a properly placed cuffed endotracheal tube, when a patient is at risk for regurgitation.' ,, The risk of aspiration, when using the LMA, can be diminished by following these manufacturer's recommendations. 1. Test the cuff for defects before use. 2. Do not lubricate the anterior surface of the mask, because the lubricant can be aspirated. 3. Obtain adequate anesthetic depth before inserting the LMA. 4. Maintain an adequate anesthetic depth throughout the surgery. 5. Avoid any stimulation on emergence. 6. Deflate the cuff only when the patient is fully awake and opens his or her mouth on command. When the LMA is properly inserted, aspiration of regurgitant fluid should not occur because the esophagus is not included in the bowl of the mask with the glottis. One study showed the glottis and the upper esophageal sphincter to be enclosed October 1995/ Vol. 63/No
5 by the LMA in 6-9% of patients examined during fiberoptic bronchoscopy. In this situation, aspiration is a possibility. 2 Other contraindications to the use of the LMA are: 1. Inability to open the mouth or extend the neck more than 1.5 cm, making insertion of the LMA difficult (e.g., ankylosing spondylitis, severe rheumatoid arthritis, cervical spine instability). 2. Low pulmonary compliance or conditions causing high airway resistance (morbid obesity, bronchospasm, pulmonary fibrosis, pulmonary edema, thoracic trauma). 3. Airway obstruction below or at the larynx. 4. Pharyngeal pathology (e.g., abscess, hematoma, tissue injury). 5. One-lung anesthesia. 2 Recently, two cases of pulmonary edema due to upper airway obstruction were reported. It is not clear if the pulmonary edema was caused by the LMA, difficulty with insertion, or light anesthesia during insertion Other problems occurring with insertion of the LMA include: 1. The tip of the LMA folding up on itself. 2. The epiglottis can become lodged in the aperture bars of the mask causing swelling and airway obstruction. 3. The epiglottis can fold on itself or the aryepiglottic folds can be forced inward causing airway obstruction. 4. Trauma to the uvula and posterior pharyngeal wall. 5. Increased cuff inflation due to prolonged use of nitrous oxide may cause airway obstruction. 1 2 LMA in the management of a difficult airway The American Society of Anesthesiologists Task Force algorithm for difficult airway management recommends insertion of an LMA when it is not possible to ventilate or intubate the trachea.' 6 In other case scenarios of difficult airway, the LMA has been inserted and used as a guide to pass a 6.0-mm internal diameter endotracheal tube over a pediatric fiberoptic bronchoscope (Figure 6) The author has had the experience of being unable to intubate a patient but was able to maintain the airway by mask. An intubating stylet was inserted through the LMA, followed by removal of the LMA, and insertion of the endotracheal tube over the tracheal tube introducer (Figure 7). Other studies have shown when a blind tracheal intubation is attempted through an LMA in a patient with normal anatomy, intubation was successful in 90% of patients The overall failure rate for an intubating stylet is 12%, while intubating over a Figure 6 Fiberopticssisted intubation through the laryngeal mask airway The external surface of a 6.0-mm internal diameter endotracheal tube is well lubricated. The endotracheal tube is inserted over a pediatric fiberoptic scope. The vocal cords must first be viewed with the fiberoptic scope, then the endotracheal tube is passed over the fiberoptic scope and through the vocal cords. The upper border of the endotracheal tube cuff is approximately 3 cm below the vocal cords. fiberoptic scope has a success rate of practically 100%. 19 There have been numerous case reports documenting expected and unexpected difficult airways being secured with an LMA. The LMA can provide an airway for a patient and then act as a guide to facilitate tracheal intubation by means of a fiberoptic scope or an intubating stylet. The LMA, used under the proper conditions, can be a valuable adjunct to anesthetic practice. REFERENCES (1) Brain AIJ, The Intavent Laryngeal Mask Instruction Manual United Kingdom: Brain Medical Ltd. October (2) Pennant JH, White PF. The laryngeal mask airway: Its uses in anesthesiology. Anesthesiology. 1993;79: Journal of the American Association of Nurse Anesthetists
6 (3) Brain AIJ. The laryngeal mask-a new concept in airway management. BrJAnaesth. 1983;55: (4) Brown GW, Patel N, Ellis FR. Comparison of propofol and thiopentone for laryngeal mask insertion. Anaesthesia 1991;46: (5) Brodrick PM, Webster NR, Nunn JF. The laryngeal mask airway: A study of 100 patients during spontaneous breathing. Anaesthesia. 1989;44: (6) Brain AIJ, McGhee TD, McAteer EJ, Thomas A, Abu-Saad MAW, Bushman JA. The laryngeal mask airway: Development and preliminary trials of a new type of airway. Anaesthesia. 1985;40: (7) Braude N, Clements AF, Hodges UM, Andrews BP. The pressor response and laryngeal mask insertion: A comparison with tracheal intubation. Anaesthesia. 1989;44: (8) Pennant JH, Walker MB. Comparison of the endotracheal tube and laryngeal mask in management by paramedical personnel. Anesth Analg. 1992;74: (9) Smith I, White PF. Use of the laryngeal mask airway as an alternative to a face mask during outpatient anthroscopy. Anesthesiology. 1992;77: (10) Benumof JL. Laryngeal mask airway: Indications and contraindications. Anesthesiology. 1992;77: (11) Griffin RM, Hatcher IS. Aspiration pneumonia and the laryngeal mask airway. Anaesthesia. 1990;45: (12) Ezri T, Priscu V, Szmuk P, Soroker D. Laryngeal mask and pulmonary edema. Anesthesiology. 1993;78:219. (13) Gajraj NM, Pennant JH, Joshi GP. Laryngeal mask airway and pulmonary edema: I. Anesthesiology. 1993;79:184. (14) Stiff G, Old S, Bapat P, Verghese C. Laryngeal mask airway and pulmonary edema: II. Anesthesiology. 1993;79: (15) Benumof JL. ASA Task Force on Difficult Airway Management Algorithm. Anesthesiology. 1991;75: (16) Benumof JL. Management of the difficult airway: The ASA Algorithm. In: ASA 1993 Annual Refresher Course Lectures. Park Ridge, Illinois: American Society of Anesthesiologists. 1993:531. (17) Heath ML, Allagain J. Intubation through the laryngeal mask: A technique for unexpected difficult intubation. Anaesthesia 1991;46: (18) Heath ML, Allagain J. The Brain laryngeal mask airway as an aid to intubation. BrJAnaesth. 1990;45:419. (19) Allison A, McCrory J. Tracheal placement of a gum elastic bougie using the laryngeal mask airway. Anaesthesia. 1990;45:419. AUTHOR LCDR Jeffrey R. Jones, CRNA, BSN, BSNA, USN, NC, is a staff nurse anesthetist at Medical Center, Oakland, California. He received his BSN degree from San Diego State University, San Diego, California. In 1989, he graduated from George Washington University with a bachelor of science in Nurse Anesthesia. ACKNOWLEDGMENT The author gratefully acknowledges the artistic work of C.J. Cummings, who is a surgical technologist and a freelance artist. The author greatly appreciates the assistance and support of CDR Paul Potter, USN, MC; LCDR Bruce Boswell, USNR, MC; and Robin Jones, RN, BSN. The opinions or assertions contained in this article are the personal views of the author and are not to be construed as official or as reflecting the views of the Navy Nurse Corps, the Department of the Navy, or the Department of Defense. October 1995/ Vol. 63/No
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 informationNeonatal 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 informationAIRWAY 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 informationOne 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 informationTRACHEOSTOMY TUBE PARTS
Page1 NR 33 TRACHEOSTOMY CARE AND SUCTIONING Review ATI Basic skills videos: Tracheostomy care and Endotracheal suction using a closed suction set. TRACHEOSTOMY TUBE PARTS Match the numbers on the diagram
More informationPediatric 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 informationThe Difficult Airway. The Difficult Airway. Difficult Airway Algorithms: ASA. Ectopic Anesthesia. Cancel Case. Awaken. airway. Defining ng the problem
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
More informationGENERAL ANESTHESIA BASICS
GENERAL ANESTHESIA BASICS INTRODUCTION The goal in the administration of general anesthesia is to provide a stage of reversible unconsciousness with adequate analgesia and muscle relaxation for surgical
More informationManagement of cuffed endotracheal tubes
A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement Scott L. Stewart, CRNA, MSN Janet A. Secrest, RN, PhD Barbara R. Norwood, RN, EdD Richard Zachary,
More informationACLS Provider Manual Supplementary Material
ACLS Provider Manual Supplementary Material 2012 American Heart Association 1 Contents Airway Management... 4 Part 1: Basic Airway Management... 4 Devices to Provide Supplementary Oxygen... 4 Overview...
More informationAirway 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 informationAEROSPACE 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 informationSecrets of the Pediatric Intubated Patient:
Secrets of the Pediatric Intubated Patient: Evidence-Based Keys to Success Leslie Grant, RN, BSN, CFRN, CCRN Matt Payne, RN, CFRN, FP-C Ranked #1 in Virginia by U.S. News & World Report VCU Total Artificial
More informationDifficult 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 informationNIM EMG Endotracheal Tube
NIM EMG Endotracheal Tube Product Information and Instructions REF I.D. (mm) O.D. (mm) FR# 9450060 6.0 8.8 27 9450061 7.0 10.2 31 9450062 8.0 11.3 34 Rx Only INTENDED USE AND DEVICE DESCRIPTION The NIM
More informationMany 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 informationPROCEDURAL 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 informationNEONATAL AND PEDIATRIC CUFFED ENDOTRACHEAL TUBES: SAFETY AND PROPER USE
ENDOTRACHEAL TUBES: SAFETY AND PROPER USE by Esther Weathers RRT, RCP RC Educational Consulting Services, Inc. 16781 Van Buren Blvd, Suite B, Riverside, CA 92504-5798 (800) 441-LUNG / (877) 367-NURS www.rcecs.com
More information(a) (b) Figure 1. (a)the components of the Classical Laryngeal mask airway. (b) Different. Department of Surgery College of MedicineAl-
THE The IRAQI Laryngeal POSTGRADUATE Mask Airway MEDICAL, JOURNAL Ahmed VOL.5, Abdulameer NO2.2006 The Laryngeal Mask Airway: technical guidelines and use in special situations Salih Summary: Recent advances
More informationInterscalene Block. Nancy A. Brown, MD
Interscalene Block Nancy A. Brown, MD What is an Interscalene Block? An Interscalene block is a form of regional anesthesia used in conjunction with general anesthesia for surgeries of the shoulder and
More informationPatient 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 informationPRACTICE 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 informationThe 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 informationAirway 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 informationCoventry 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 informationFire Risk Assessment Tool: Instructions for Use
Fire Risk Assessment Tool: Instructions for Use Purpose of the Fire Risk Assessment Tool: To assist the perioperative team in determining and communicating the potential fire risk for each individual patient.
More informationDepartment 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 informationFemoral Nerve Block/3-in-1 Nerve Block
Femoral Nerve Block/3-in-1 Nerve Block Femoral and/or 3-in-1 nerve blocks are used for surgical procedures on the front portion of the thigh down to the knee and postoperative analgesia. Both blocks are
More informationAcute 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 informationAHA/AAP Neonatal Resuscitation Guidelines 2010: Summary of Major Changes and Comment on its Utility in Resource-Limited Settings
AHA/AAP Neonatal Resuscitation Guidelines 2010: Summary of Major Changes and Comment on its Utility in Resource-Limited Settings Resuscitation step Recommendations (2005) Recommendations (2010) Comments/LOE
More informationContinued 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 informationMODEL 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 informationProcedure -8. Intraosseous Infusion Adult and Pediatric EZIO. Page 1 of 7 APPROVED:
Page 1 of 7 Intraosseous Infusion Adult and Pediatric APPROVED: EMS Medical Director EMS Administrator 1. Goals/Introduction: 1.1 Intraosseous (IO) infusion provides an effective alternative means of providing
More informationendotracheal tube guide We provide Rusch quality.
endotracheal tube guide We provide Rusch quality. 2 RUSCH ENDOTRACHEAL TUBE GUIDE RUSCH ENDOTRACHEAL TUBE GUIDE 3 subglottic secretion removal a vap reduction strategy Ventilator-Associated Pneumonia (VAP)
More informationTOWN 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 informationAirway 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 informationLASER Safety in the Operating Room. Andrew Dick Resident Research Night February 20 th, 2008
LASER Safety in the Operating Room Andrew Dick Resident Research Night February 20 th, 2008 LASER LASER is an Acronym Light Amplification by Stimulated Emission of Radiation Lasers work on several principles
More informationSpeech and Swallowing Therapy for. A Basic Understanding
Speech and Swallowing Therapy for Tracheostomized Patients A Basic Understanding Objectives Participants will be able to identify diseases and conditions that can result in respiratory failure. Participants
More informationBier Block (Intravenous Regional Anesthesia)
Bier Block (Intravenous Regional Anesthesia) History August Bier introduced this block in 1908. Early methods included the use of two separate tourniquets and procaine was the local anesthetic of choice.
More informationTarget groups: Paramedics, nurses, respiratory therapists, physicians, and others who manage respiratory emergencies.
Overview Estimated scenario time: 10 15 minutes Estimated debriefing time: 10 minutes Target groups: Paramedics, nurses, respiratory therapists, physicians, and others who manage respiratory emergencies.
More informationAn 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 informationNEEDLE THORACENTESIS Pneumothorax / Hemothorax
NEEDLE THORACENTESIS Pneumothorax / Hemothorax By: Steven Jones, NREMT-P Pneumothorax Pneumothorax is a collection of air or gas in the pleural space of the lung, causing the lung to collapse. Pneumothorax
More informationONE-LUNG VENTILATION. Dr Lesley Strachan Consultant Anaesthetist Aberdeen Royal Infirmary. Self Assessment
ONE-LUNG VENTILATION Dr Lesley Strachan Consultant Anaesthetist Aberdeen Royal Infirmary Self Assessment Complete these questions before reading the tutorial. 1. What are the indications for inserting
More informationAWAKE 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 informationUC 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 informationMONITORING THE ANESTHETIZED PATIENT
MONITORING THE ANESTHETIZED PATIENT The administration and monitoring of anesthesia for surgical procedures is a complex and multifaceted skill that requires both knowledge and practice. The safety of
More informationLESSON 4 ORAL, NASOPHARYNGEAL, AND NASOTRACHEAL SUCTIONING.
LESSON 4 ORAL, NASOPHARYNGEAL, AND NASOTRACHEAL SUCTIONING. 4-1. SUCTIONING a. Suctioning is a common nursing activity performed for the purpose of removing accumulated secretions from the patient's nose,
More informationSurgical Safety Checklists and Briefings Clinician s User Guidelines
Surgical Safety Checklists and Briefings Clinician s User Guidelines 3/15/2009 Surrey Memorial Hospital Author: Keith Martinsen Before Induction Checklist Surgeon s Team Briefing Before Skin Incision Checklist
More informationA. function: supplies body with oxygen and removes carbon dioxide. a. O2 diffuses from air into pulmonary capillary blood
A. function: supplies body with oxygen and removes carbon dioxide 1. ventilation = movement of air into and out of lungs 2. diffusion: B. organization a. O2 diffuses from air into pulmonary capillary blood
More informationLiposuction GUIDELINE
.goo NON HOSPITAL MEDICAL AND SURGICAL FACILITIES PROGRAM College of Physicians and Surgeons of British Columbia Liposuction GUIDELINE You may download, print or make a copy of this material for your noncommercial
More informationX-Plain Sinus Surgery Reference Summary
X-Plain Sinus Surgery Reference Summary Introduction Sinus surgery is a very common and safe operation. Your doctor may recommend that you have sinus surgery. The decision whether or not to have sinus
More informationEnables 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*Reflex withdrawal from a painful stimulus is NOT considered a purposeful response.
Analgesia and Moderate Sedation This Nebraska Board of Nursing advisory opinion is issued in accordance with Nebraska Revised Statute (NRS) 71-1,132.11(2). As such, this advisory opinion is for informational
More informationVirginia 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 informationLiau DW : Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. ASA Newsletter 70(6): 11-13 & 16, 2006.
Citation Liau DW : Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. ASA Newsletter 70(6): 11-13 & 16, 2006. Full Text An anesthesiologist inserted a 14-gauge peripheral
More informationNCCEP Standards. NCCEP Standards for EMS Equipment
NCCEP Standards NCCEP Standards for EMS Equipment Performance Standards 2009 . The baseline equipment required in all systems (including Specialty Care Transport Programs) with EMS personnel credentialed
More informationTHE 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 informationMARYLAND STATE SCHOOL HEALTH SERVICES GUIDELINES
Department of Health and Mental Hygiene Maryland State Department of Education Maryland State School Health Council MARYLAND STATE SCHOOL HEALTH SERVICES GUIDELINES Emergency Management Guidelines for
More informationMississippi Board of Nursing
Mississippi Board of Nursing Regulating Nursing Practice www.msbn.state.ms.us 713 Pear Orchard Road, Suite 300 Ridgeland, MS 39157 Administration and Management of Intravenous (IV) Moderate Sedation POSITION
More informationHow To Intubate
Laryngoscopy and intubation of infants and children DAVID V. SHAVER, Jr., CRNA, BSN New Orleans, Louisiana Preoperative preparation of infants and children and indications for oral and nasal tracheal intubation
More informationLASER INSTRUMENTATION
509201 509202 509204 509205 509206 509207 509203 LASER INSTRUMENTATION Laser Instrumentation (Ebonized) Ossoff-Karlan Laser Instruments Pilling recoends the Ossoff-Karlan Laser Instrumentation presented
More informationCredentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist
Credentialing Criteria for Privileges to Administer Sedation/Analgesia by the Non- Anesthesiologist Administrative Policy & Procedure - Jersey Shore University Medical Center Document Number: JM-ADMIN-0004
More informationVascular Access. Chapter 3
Vascular Access Chapter 3 Vascular Access Introduction Obtaining vascular access in infants and children can be difficult even under optimal conditions. Attempting emergent access in a hypotensive, struggling
More informationAnesthesia Information for Patients
Anesthesia Information for Patients D. John Doyle MD PhD Written April 2006. Updated April 2012. Do I have to go to sleep for my surgery? Not necessarily - not all surgery requires that patients undergo
More informationRespiratory System. Chapter 21
Respiratory System Chapter 21 Structural Anatomy Upper respiratory system Lower respiratory system throat windpipe voice box Function of Respiratory System Gas exchange Contains receptors for sense of
More informationX-Plain Trigeminal Neuralgia Reference Summary
X-Plain Trigeminal Neuralgia Reference Summary Introduction Trigeminal neuralgia is a condition that affects about 40,000 patients in the US every year. Its treatment mostly involves the usage of oral
More informationClinical Site Resource Manual. Northport Medical Center- DCH
Clinical Site Resource Manual Northport Medical Center- DCH Nurse Anesthesia Program School of Health Related Professions The University of Alabama at Birmingham TABLE OF CONTENTS Section 1 CLINICAL SITE
More informationCardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008
Cardiac Arrest Pediatric Ventricular Fibrillation / Pulseless Ventricular Tachycardia Protocol revised October 2008 Preamble In contrast to cardiac arrest in adults, cardiopulmonary arrest in pediatric
More informationCH CONSCIOUS SEDATION
Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision
More informationPHSW 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 informationModule 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 informationComplications of managing the airway
Best Practice & Research Clinical Anaesthesiology Vol. 19, No. 4, pp. 641 659, 2005 doi:10.1016/j.bpa.2005.08.002 available online at http://www.sciencedirect.com 7 Complications of managing the airway
More informationConundrums 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 informationAddendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context
Addendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context A subcommittee of the Canadian Neonatal Resuscitation Program (NRP) Steering Committee
More informationX-Plain Preparing For Surgery Reference Summary
X-Plain Preparing For Surgery Reference Summary Introduction More than 25 million surgical procedures are performed each year in the US. This reference summary will help you prepare for surgery. By understanding
More informationROLE 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 informationDRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement
Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Many patients with emergency medical conditions in emergency and critical care settings frequently experience treatable pain,
More informationAdministrative Manual
I. Description Administrative Manual Policy Name Pediatric Sedation Policy For Non- Anesthesiologists Policy Number ADMIN 0212 Date this Version Effective March 1, 2011 Responsible for Content Pediatric
More informationVacuum mattress, Bariatric Transfer, Monitoring Documents Lisa Curatolo / Pete Davis Reviewer Stephen Hearns / Alistair Kennedy
Emergency Medical Retrieval Service (EMRS) www.emrs.scot.nhs.uk Standard Operating Procedure Public Distribution Title Packaging Version 9 Related Vacuum mattress, Bariatric Transfer, Monitoring Documents
More informationDepartment of Surgery
What is emphysema? 2004 Regents of the University of Michigan Emphysema is a chronic disease of the lungs characterized by thinning and overexpansion of the lung-like blisters (bullae) in the lung tissue.
More informationSign up to receive ATOTW weekly - email worldanaesthesia@mac.com
ONE LUNG VENTILATION ANAESTHESIA TUTORIAL OF THE WEEK 145 3 RD AUGUST 2009 Dr B D Rippin Leeds General Infirmary, Leeds, UK Dr S Kritzinger St James University Hospital, Leeds, UK Correspondence to benrippin@doctors.net.uk
More informationADMINISTERING EMERGENCY OXYGEN
FACT SHEET ADMINISTERING EMERGENCY OXYGEN Emergency oxygen can be given for many breathing and cardiac emergencies. It can help improve hypoxia (insufficient oxygen reaching the cells) and reduce pain
More informationTitle/Subject Procedural Sedation and Analgesia Page 1 of 10
Policy Procedural Sedation and Analgesia Page 1 of 10 Scope: Providers and nurses (M.D., D.O., D.M.D., D.D.S., A.P.R.N., P.A., R.N.) with appropriate privileges and who have successfully demonstrated adequate
More informationANAESTHETIC MANAGEMENT FOR ATLANTO AXIAL SUBLUXATION
ANAESTHETIC MANAGEMENT FOR ATLANTO AXIAL SUBLUXATION Pages with reference to book, From 12 To 16 Rehana S. Kamal, Fauzia A. Khan ( Department of Anaesthesiology, The Aga Khan University Hospital & Medical
More informationPerioperative 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 informationSpeech Therapy for Cleft Palate or Velopharyngeal Dysfunction (VPD) Indications for Speech Therapy
Speech Therapy for Cleft Palate or Velopharyngeal Dysfunction (VPD), CCC-SLP Cincinnati Children s Hospital Medical Center Children with a history of cleft palate or submucous cleft are at risk for resonance
More informationHuman Digestive System Anatomy
Human Digestive System Anatomy Biology 104 Objectives: 1. Learn the anatomy of the digestive system. You should be able to find all terms in bold on the human torso models. 2. Relate structure of the system
More informationOver the past decade, video laryngoscopy has profoundly. The Video Laryngoscopy Market: Past, Present, and Future
PRINTER-FRIENDLY VERSION AVAILABLE AT ANESTHESIOLOGYNEWS.COM The Video Laryngoscopy Market: Past, Present, and Future KENNETH ROTHFIELD, MD Chairman Department of Anesthesiology Saint Agnes Hospital Baltimore,
More informationBasic ATLS. The Primary Survey. Jason Smith MD DMI FRCS(Gen.Surg) Consultant Surgeon
Basic ATLS The Primary Survey Jason Smith MD DMI FRCS(Gen.Surg) Consultant Surgeon Trauma - expression comprising a spectrum of severity of mechanical violation of tissues, from a little scratch to a multiply
More informationKeeping your lungs healthy
Keeping your lungs healthy A guide for you after spinal cord injury and other neurological conditions Regional Rehabilitation Program This booklet has been written by the health care providers who provide
More informationIII-701 Urinary Catheterization/Bladder Irrigation Original Date: 3/1/1977 Last Review Date: 10/28/2004
III-701 Urinary Catheterization/Bladder Irrigation Original Date: 3/1/1977 Last Review Date: 10/28/2004 Purpose A. Allow for precise measurement of urine output. B. Collect a sterile urine specimen. C.
More informationKEYHOLE HERNIA SURGERY
Disclaimer This movie is an educational resource only and should not be used to manage a hernia or abdominal pain. All decisions about the management of a hernia must be made in conjunction with your Physician
More informationEMPHYSEMA THERAPY. Information brochure for valve therapy in the treatment of emphysema.
EMPHYSEMA THERAPY Information brochure for valve therapy in the treatment of emphysema. PATIENTS WITH EMPHYSEMA With every breath, lungs deliver oxygen to the rest of the body to perform essential life
More informationAirway 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 informationOxygen - update April 2009 OXG
PRESENTATION Oxygen (O 2 ) is a gas provided in compressed form in a cylinder. It is also available in liquid form, in a system adapted for ambulance use. It is fed via a regulator and flow meter to the
More informationAnkle Block. Indications The ankle block is suitable for the following: Orthopedic and podiatry surgical procedures of the distal foot.
Ankle Block The ankle block is a common peripheral nerve block. It is useful for procedures of the foot and toes, as long as a tourniquet is not required above the ankle. It is a safe and effective technique.
More informationState 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 informationMODERATE 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 informationChapter 2 - Anatomy & Physiology of the Respiratory System
Chapter 2 - Anatomy & Physiology of the Respiratory System Written by - AH Kendrick & C Newall 2.1 Introduction 2.2 Gross Anatomy of the Lungs, 2.3 Anatomy of the Thorax, 2.4 Anatomy and Histology of the
More informationProposed 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