SCCM Resource Library-Airway Management

Pdf Summary

The document outlines comprehensive guidelines and techniques for airway management, focusing on endotracheal intubation, alternative airway techniques, and pharmacological preparation. Key objectives include recognizing indications for intubation, signs of airway compromise, and employing various methods to manually maintain airway patency.<br /><br />Airway management is critical for critically ill patients to ensure proper oxygenation and carbon dioxide elimination. First, assess a patient's level of consciousness and any potential threats to airway patency. Manual methods include neck extension, jaw thrust, and opening the mouth to maintain airway patency. Tools such as oropharyngeal and nasopharyngeal airways are helpful, provided there are no contraindications like an intact gag reflex or facial trauma.<br /><br />The document emphasizes mastering manual mask ventilation, ensuring a tight seal to prevent air leaks and optimizing ventilation. When intubation is challenging or ventilation fails, supraglottic airway (SGA) devices like the laryngeal mask airway (LMA) are recommended. SGA devices are crucial "lifelines" in cannot intubate, cannot ventilate (CICV/CICO) scenarios.<br /><br />For pharmacological preparation, the appropriate agents should provide sedation, amnesia, and analgesia without compromising stability. Etomidate and ketamine are typically preferred in unstable patients, though ketamine aids sympathetic tone. Succinylcholine and rocuronium are common neuromuscular blockers, but care must be taken with potential contraindications and adverse effects.<br /><br />In difficult situations, alternatives to direct laryngoscopy, such as video laryngoscopy or awake intubation, may be indicated. Airway algorithms assist in navigating complex cases. Lastly, maintaining vigilance for hemodynamic changes post-intubation is critical, as complications such as hypotension are common. The document stresses the importance of training and familiarity with all these procedures for safe and effective airway management in critical care settings.

Asset Subtitle

Pulmonary, 2021, 9:20:00

Asset Caption

This is a complimentary chapter from the textbook,Fundamental Critical Care Support, 7th edition , titled "Airway Management."
Learning Objectives

Recognize the indications for endotracheal intubation and signs of impending airway compromise..
Discuss the key management principles of these devices.
Discuss the different techniques used to manually establish a patent airway and ensure adequate mask ventilation.
Elucidate the different types and proper use of tools to supplement airway management, including the use of supraglottic airways.
List the necessary equipment needed for endotracheal intubation, the clinical signs of a potentially difficult airway, and alternatives to direct laryngoscopy to accomplish endotracheal intubation.
Delineate alternatives to establish an airway when endotracheal intubation is not feasible.
Discuss the difficult airway algorithm and approaches to avoid and/or rectify the Can’t Intubate, Can’t Ventilate/Oxygenate (CICV/CICO) scenario.
Identify the pharmacologic agents used to facilitate airway management, their classification, indications, and potential adverse effects/contraindications.

Meta Tag

Content Type Book Chapter

Knowledge Area Pulmonary

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Airway Management

Year 2021

Keywords

airway management

endotracheal intubation

pharmacological preparation

manual ventilation

supraglottic airway

video laryngoscopy

sedation

neuromuscular blockers

hemodynamic changes

critical care

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