Kaylas Blind Insertion Airway review Lab quiz 2

what year did blind insertion airways become prominent in EMS

80’s

what is the goal of blind insertion airways

bridge the gap between respiratory arrest and airway management when endotracheal intubation is not possible

what do blind inserrtion airways do for the patient

provide quick access, easy to secure patients airways and ventilate their lungs

What are the benefits of blind insertion airways

indirect route to the trachea / lungs

protects the airway

improves ventilation

limits gastric distension

connection for end tidal CO2 monitor

Emergency airways in case of failed endotracheal intubation

In procedure of blind insertion airways how do you confirm correct placement

check make sure chest wall rise is symmetrical, auscultation of equal breath sounds over the chest and lack of epigastric sounds : noises, clicks, gurgles

what is the procedure for blind insertion airway

open oxygen tank, fill oxygen in bag valve, insert tube

confirm its appropriately placed in the patient by looking for symmetrical chest rise, auscultation of equal breath sounds and lack of gurgling with bag valve mask ventilation and capnography if available.

secure devide

document the time, provider, provider level and success of the procedure

complete all airway confirmation fields cehst rise, bilateral equal breath sounds, absense of epigastric sounds or end tidal Co2 readings

reassess placement of tube frequently especially after patient moves

what are the complications of blind insertion airways

initial misplacemnt

dislodgement : was in correct place but then moved

Patient will die if misplacement is unrecognized. they can also have trauma to the airway like bleeding or swelling

Airway anatomy: Nasopharynx, Oropharynx, Larynopharynx. What parts are in each section

Nasopharynx: hard palate, soft palate

Oropharynx: tonsil, tongue

Laryngopharynx: epiglottis, vocal cords

look at this

General procedures for blind insertion airways

uPrepare equipment (including suction)

uBody substance isolation including mask, eye shield

uPre-oxygenate patient

uPosition head

uOpen airway with jaw lift

uPass device

uInflate cuff and immediately disconnect syringe

uVerify correct tube placement by at least 2 methods

uSecure tube with a commercially prepared device

uReassess placement after any patient lifting/moving

what are the different blind insertion airway devices for EMTs

King LTD or LTSD : MGregror uses it , i gel: lee fire department uses it , Air Q

what is the equipment used for blind insertion airways

Suction device with FR suction catheter, BVM, O2,EtCO2 if available

what is the insertion procedure

uPlace the patient in a supine position

uVentilate via BVM and pre-oxygenate the patient with 100% oxygen prior to device insertion

what do you need to verify during blind insertion airways

uDuring ventilation observe end-tidal CO₂ monitor and pulse oximetry to confirm adequate ventilation, oxygenation

Gel airways

have rapid, easy insertion, their is not inflatiion or syringes required

can be prone to unseating because they dont have baloons in place to keep the pressure secreated

take a little more riske using an I gel tube than a King tube

what are the mutliple methods to verify airway placement

equal chest rise

bilateral lung auscultation

Negative auscultation of ABD

ETCO2 wave form

what is a gold standard for verifying airway confirmation

capnography

true or false: do not ventilate stomach if you have good capnography wave form

true

what is capnography

its a continuous, non invasive measurement and graphical display of CO2 in exhaled breath

airway displacement

uEven if secured properly at the lips, tube movement up to 2 cm can occur at distal end

u

uThis is enough to displace your tube!

u

uUse continuous EtCO2 monitoring

u

uReassess tube placement after any significant movement of patient

uPt. to stretcher, loading / unloading stretcher from ambulance, etc.

Ventilation rates are how many breaths per minute depending on pt. age

10-12

how many ml is tidal volume

400-500ml

dont squeeze entire bag : 1500 mL : can over inflate the lungs

why do you want smaller tidal volumes when ventilating patient

Due to better access to lungs and 100% supplemental oxygen

watch chest rise don’t over inflate

excessive tidal volumes lead to increased intrathoracic pressure and decreased blood flow

Do not let go of BVM and let it drag on the tube you will traumatically extubate the patient

Keys to Success

uPreparation of equipment

uHave everything ready, including EtCO2, suction, tube tamer

u

uPosition yourself and patient

u

uAssess, Re-assess, Re-re-assess

u

uPRACTICE, PRACTICE, PRACTICE!