Airway Management Principles and Techniques

A clinical assessment that helps to predict the difficulty of intubation.

A procedure for rapidly intubating patients who need immediate airway management, but aren't in a crisis situation.

An algorithm used for intubating patients who are in cardiopulmonary arrest or near arrest.

A procedure used to confirm the placement of an endotracheal tube (ETT) in the trachea, ensuring correct placement for ventilation.

A monitoring technique used to assess oxygen saturation in critically ill patients.

Three failed attempts at intubation by a skilled clinician, using the best possible patient position, device, and technique. This usually triggers a failed airway algorithm.

A situation where immediate action is required despite the high risk of difficult intubation. The patient's condition is rapidly worsening, and delay is unacceptable.

A systematic approach to identifying potential airway difficulties, but not a decision-making tool for medication administration.

Making sure the patient is positioned correctly and using the right equipment (like a videolaryngoscope) for intubation.

Taking into account the patient's anatomy and underlying health conditions when managing a potentially difficult airway.

End-tidal carbon dioxide (ETCO2) detection is a reliable way to confirm proper tracheal intubation.

Six manual breaths are required to verify the presence of CO2 after intubation.

The absence of CO2 after six breaths during intubation suggests esophageal intubation.

Ultrasound imaging can be used to confirm tracheal intubation when ETCO2 detection is not possible.

A gum elastic bougie can be used to further corroborate tracheal tube location.

Quantitative or qualitative ETCO2 detection, with ultrasound or the bougie technique as backup, are the primary means of confirming ETT placement.

Maximizing oxygen in the lungs before intubation to create an oxygen reserve during the brief period of apnea.

Ensuring patients are not at risk of aspirating stomach contents, making them the right candidate for RSI procedure.

Administering drugs that induce paralysis to facilitate intubation and prevent aspiration.

The series of distinct steps performed during RSI, ensuring patient safety and successful intubation.

A situation where traditional airway management techniques like bag-valve-mask ventilation (BMV) have failed to adequately oxygenate the patient, leading to a life-threatening situation with an urgent need for an airway.

A planned approach for securing an airway in anticipated difficult cases, prioritizing a cuffed endotracheal tube (ETT) placement.

The potential for obese patients to rapidly lose oxygen levels after intubation.

The importance of monitoring and having backup tools and a plan in case of complications during intubation.

A surgical procedure involving a small incision in the neck's cricothyroid membrane, providing immediate access to the airway, used when other methods fail.

Using RSI to manage blood pressure and heart rate in patients with hypertensive crises.

A systematic approach to managing a failed airway, prioritizing immediate oxygenation, using stepwise escalation of interventions, and focusing on a definitive airway.

A rapid sequence intubation technique where a patient is preoxygenated with 100% oxygen, then given a sedative like etomidate and a paralytic like succinylcholine, followed by intubation using a laryngoscope.

A type of intubation where patients are sedated and given topical anesthetic agents, but NOT paralyzed. They can still breathe on their own but are relaxed enough for easy intubation.

A method where high doses of a drug like ketamine are given before intubation. This helps with sedation and deep breathing, improving oxygen levels in the lungs.

Drugs used during RSI and DSI to relax muscles and make intubation easier.

A type of NMBA like succinylcholine that binds to muscle receptors, causing them to contract and then relax.

A type of NMBA that blocks the action of acetylcholine at nerve-muscle junctions, preventing muscle contraction.

The process of giving a patient 100% oxygen before intubation to maximize oxygen levels in their lungs.

A maneuver used during intubation to press on the cricoid cartilage, helping to prevent stomach contents from being aspirated into the lungs.

A drug that can be used as a sedative for awake oral intubation. It provides sedation, pain relief, and maintains airway reflexes.

This drug can be used alone or with others during awake oral intubation. It's a sedative drug that helps calm patients and provide sedation for the procedure.

A phencyclidine derivative used as a general anesthetic, known to induce a cataleptic state, preserving airway reflexes and ventilatory drive.

A widely used anesthetic agent, its action is characterized by GABA receptor stimulation, leading to sedation and amnesia. It is often preferred for head-injured patients due to its ability to reduce ICP.

This induction agent is ideal for emergency RSI in patients with severe asthma or hemodynamic instability due to its ability to support blood pressure.

This induction agent is useful for patients with elevated ICP as it reduces intracranial pressure and cerebral oxygen use. However, it may cause hypotension.

A benzodiazepine used in emergency airway management. It causes loss of consciousness in approximately 30 seconds, with a clinical duration of 15–20 minutes.

This induction agent is more commonly used for procedural sedation or awake intubation, but not for RSI.

This method is recommended for the rapid intubation of patients in status asthmaticus, where rapid airway control is crucial.

These considerations involve a meticulous assessment of a patient's airway anatomy, including the presence of any potential obstacles that can hinder effective intubation.

This device can reduce the work of breathing and provide supplemental oxygenation in patients with status asthmaticus, enhancing overall respiratory management.

This procedure involves the use of a flexible endoscopic instrument to guide the placement of the endotracheal tube, allowing for a safer and more controlled intubation process.

A technique used to insert a tube into the windpipe (trachea) without directly seeing the airway. It relies on the experience and skill of the person performing the procedure.

Devices used to monitor the patient during and after intubation, helping to ensure the tube is in the right place and the patient is getting enough air.

Verifying the endotracheal tube is properly positioned in the trachea, using methods like listening to breath sounds and checking a chest X-ray.

Methods used to confirm the endotracheal tube is in the trachea and not the esophagus, including listening to breath sounds, checking the chest X-ray, and measuring carbon dioxide levels.

The process of ensuring the patient gets enough air and oxygen throughout the intubation procedure, both before, during and after.

A fast-acting muscle relaxant used to quickly paralyze a patient's muscles, allowing for easier intubation. It's also used in other medical procedures like electroconvulsive therapy.

A medication that helps control seizures by reducing neuronal activity in the brain, making intubation safer for patients experiencing seizures.

A critical technique used to establish an airway in a patient who needs urgent and immediate assistance breathing. It involves swiftly inserting a tube through the nose and into the trachea.

The process of introducing a tube through the mouth and into the trachea to secure an airway, providing a reliable route for breathing assistance.

This procedure involves inserting a tube through the mouth, securing a secure airway, but is challenging in emergencies.

Various medications are used to address other medical conditions, such as pain relief, controlling agitation, or managing underlying health problems, aiding in the effectiveness of intubation.

This involves providing a patient with 100% oxygen before intubation to create an oxygen reserve, especially during the temporary pause in breathing that occurs during the procedure.

A device that assists in breathing by applying continuous positive airway pressure (CPAP) to help maintain an open airway and improve gas exchange in patients with respiratory distress.

A failed airway refers to a situation where traditional airway management techniques like bag-valve-mask ventilation (BMV) have failed to adequately oxygenate the patient, leading to a life-threatening situation with an urgent need for an airway.

A difficult airway refers to a planned approach for securing an airway in anticipated difficult cases. In these cases, the medical team prioritizes a cuffed endotracheal tube (ETT) placement, which ensures a secure airway.

A group of medications used to relax muscles and make intubation easier. They work by blocking signals between nerves and muscles.

A type of NMBA that binds to muscle receptors, causing them to contract and then relax. It's used for quick paralysis during intubation.

A surgical procedure involving a small incision in the neck's cricothyroid membrane, providing immediate access to the airway, used when other methods fail.

Succinylcholine is a muscle relaxant used in rapid sequence intubation (RSI) - a procedure to quickly secure an airway. However, in elderly patients, its use requires special consideration due to age-related changes in how their bodies process and respond to medications.

The enzyme responsible for breaking down succinylcholine is called plasma cholinesterase. It's activity varies with age. Both infants and older adults may have reduced enzyme activity, leading to prolonged muscle relaxation, which can be risky.

Older adults may have decreased liver blood flow and function, affecting how their bodies process succinylcholine. This can contribute to prolonged effects of the drug.

Patients with specific conditions like muscle weakness diseases (myasthenia gravis) or reduced plasma cholinesterase levels should not receive succinylcholine.

Adjusting succinylcholine dosage in elderly patients is challenging due to limited specific data for their age group. Close monitoring of the patient's response and adjusting the dose accordingly are crucial.

Succinylcholine can cause heart rhythm abnormalities, like slow heart rate, particularly in elderly patients with underlying heart conditions. Closely watching the heart's electrical activity is essential.

Succinylcholine's effects on the heart can be more pronounced in elderly patients, particularly those with existing heart problems. Close monitoring of heart rate and rhythm is vital during and after administration.

Given potential risks with this drug, alternative muscle relaxants may be considered for elderly patients, especially those with reduced plasma cholinesterase or other health issues.

Succinylcholine's effects can last longer in older adults due to reduced levels of the enzyme that breaks it down in the body.