Management of failed intubation Flashcards
What are the three different scenarios in which management of a failed intubation is required?
- During routine induction
- During RSI with sux
- In the paralyzed patient
How can it be established that the Bougie is in the trachea
- clicks from tracheal rings
if not - advance to 45 cm - resistance from bronchial tree
- cough
if no resistance met or no cough –> likely in the oesophagus
Design purpose of intubating LMA
Facilitate tracheal intubation whilst maintaining ventilation and oxygenation
Design purpose of ProSeal LMA
Designed for positive pressure ventilation
What is the Brimacombe technique for insertion of the ProSeal LMA
Use bougie in gastric aspiration channel to guide tip of ProSeal LMA into the oesophagus rather than impacting in the supraglottic area in the supine patient in which the upper oesophagus can be a potential space rather than a space due to the effect of gravity.
Describe the overall management of failed intubation plan
Plan A - Initial intubation plan
Plan B - Secondary tracheal intubation plan
Plan C - Maintenance of O2, Ventilation and postponement of surgery and awakening
Plan D - Rescue techniques for CICV
Describe the practical points of intubation Plan A,B,C,D for failed intubation in routine induction
A - 1º: Anaesthesia, muscle relaxation, sniffing, OELM
B - 2º: Intubate through LMA (cLMA, PLMA, ILMA)
C - Failure x 4 attempts - postpone elective surgery LMA/BVM until patient awake.
D - CICO –> Front of neck access
What is the difference in the approach to Plan A,B,C,D for failed intubation in RSI
A - 1º: PreO2 + cricoid pressure (reduced if impeding laryngoscopy
Anaesthesia, muscle relaxation, sniffing, OELM
B - NO SECONDARY ATTEMPTS AT INTUBATION
C - LMA/BVM until patient awake. Postpone surgery unless life threatening
D - CICO –> Front of neck access
