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Flashcards in Difficult Airway Algorithm Deck (6)
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1

First four steps of the dificult airway algorythm

(stop at the algorithm)

  1. Asssess the likelyhood of basic management problems
    • Difficult ventilation
    • Difficult intubation
    • Difficulty with consent or cooperation
    • Difficult tracheostomy
  2. ​Deliver supplimental oxygen throughout
  3. Consider merits and feasible management choices: 
    1. Awake vs intubation after general anesthesia
    2. Non-invasive vs invasive technique to intubation
    3. Preservation  vs Ablation of spontaneious ventilation
  4. ​Develop primary and alternative strategies

2

Develop primary and alternative strategies

Side A 

  1. Awake intubation
    • invasive or non-invasive approach to intubation
  2. If this FAILS
    • Cancel case
    • consider feasibility of other options
    • if you attempted a non-invasive approach  - you can attempt an invasive approach

3

Develop primary and alternative strategies

Side B

Non-emergency pathway

  1. The initial intubation was unsucessful
  2. Consiter from here on:
    1. Calling for help
    2. Returning to spontaneous ventilation
    3. awakening the pateint
  3. If you are ABLE to mask ventilate it is the NON-EMERGENCY pathway
    • ​this means the intubation failed but ventilation is adequate
  4. ​​Alternate approaches to intubation
    • ​​try a different blade
    • use the LMA as a conduit
    • Use and intubating stylet
    • Retrograde intubation
    • Light Wand
    • Blind oral/nasal intubation
  5. ​Still fail after multiple attempts
    • ​Consider invasive airway access (tracheostomy, cricothyrotomy)
    • Consider other feasible options
    • Awaken the patient

4

Develop primary and alternative strategies

Side B

Emergency pathway

  1. The initial intubation was unsucessful
  2. Consiter from here on:
    • Calling for help
    • Returning to spontaneous ventilation
    • awakening the pateint
  3. If facemask ventilation is not adequate
    • Consider/Attempt an LMA
  4. ​If the LMA is not feasible and you are UNABLE to mask ventilate it is the EMERGENCY pathway
    • ​this means the intubation failed unable to provide adequate ventilation 
  5. ​​​CALL FOR HELP!!!
  6. Emergency NON-Invasive airway ventilation
    • ​Rigid bronchoscope
    • Esophageal-tracheal combitube ventilation
    • Transtracheal jet ventilation
  7. If this fails go to INVASIVE airway ventilation
    • ​tracheostomy
    • cricothyrotomy

5

Difficult Airway Management

Pink one

6

ASA Difficult Airway Algorythm