CH01_001_005

Airway Management■■ Mnemonics Rapid Triage A—Alert Patient Assessment V—Responds to Verbal A—Airway P—Responds to Pain B—Breathing U—Unresponsive C—Circulation D—Disability Pain Questions E—Expose O—Onset P—Provoke/Palliative Altered Mental Status Q—Quality/Character A—Alcohol/Drugs R—Region or Radiation E—Endocrine S—S igns/Symptoms/ I —Insulin/Infection O—Overdose Severity U—Uremia T—T ime of Onset/ T—Trauma Duration/Intensity I —Infection P—Psychiatric Newborn Assessment S—Shock A—Appearance P—Pulse History-Taking G—Grimace S—Signs and Symptoms A—Activity A—Allergies R—Respirations M—Medications P—Pertinent Past History L—Last meal E—EventsAirway781284041095_CH01_001_005.indd 1 24/04/15 7:17 pm

Airway 2■■ Laryngeal Mask Airway 3 4Contraindications—Severe oropharyngeal 5trauma; poorly tolerated in conscious 6patients.1. C-spine immobilization, as needed.2. Deflate cuff. Lubricate posterior (palatal) s­ urface of LMA.3. Preoxygenate with 100% O2.4. Extend head; flex neck; place LMA against hard palate.5. Follow natural curve of patient’s airway, i­nsert LMA until it is seated snugly.6. Inflate cuff with just enough air (see chart); do not hold tube down during inflation; allow LMA to “seat itself.”7. Verify proper placement: ■ Check chest expansion and lung sounds. ■ Secure with tape or tube holder. ■ Apply CO2 detector; oximeter. ■ Reassess airway periodically.Patient Size LMA Size Maximum Cuff VolumeNeonate/infant: up to 5 kg 1 Up to 4 mLInfant: 5–10 kg 1½ Up to 7 mLInfant/child: 10–20 kg 2 Up to 10 mLChild: 20–30 kg 2½ Up to 14 mLChild: 30–50 kg 3 Up to 20 mLNormal adult: 50–70 kg 4 Up to 30 mLLarge adult: 70–100 kg 5 Up to 40 mLLarge adult: > 100 kg 6 Up to 50 mL781284041095_CH01_001_005.indd 2 24/04/15 7:17 pm

■■ King LT AirwayContraindications—Patients < 4 ft tall; does 2not protect against aspiration. 31. C-spine immobilization, as needed. 4 6 Preoxygenate with 100% O2. Apply 8 water-based lube to distal tip and posterior aspect of tube. 24/04/15 7:17 pm2. Deflate cuff. Open mouth, apply chin lift, insert tip into side of mouth.3. Advance tip behind tongue while rotating tube to midline.4. Advance tube until base of ­connector is aligned with teeth or gums.5. Inflate cuff with air (use minimum volume necessary).Patient Size LT Size Cuff Volume (mL)35–45 in 2 25–3541–51 in 2.5 30–404–5 ft 3 45–605–6 ft 4 60–80> 6 ft 5 70–906. Attach bag-valve device. While ­ventilating, gently withdraw tube until ventilation b­ ecomes easy.7. Adjust cuff inflation, if necessary, to obtain a good seal.8. Verify proper placement: ■ Check chest expansion and lung sounds. ■ Apply CO2 detector; oximeter. ■ Secure with tape or tube holder. ■ Reassess airway periodically. 3Airway781284041095_CH01_001_005.indd 3

Airway 4■■ Combitube®Contraindications—Gag reflex, esophageal disease, causticingestion, under 16 yo or < 5 ft tall (use Combitube SA® forsmall adult).1. Immobilize C-spine if spinal trauma; preoxygenate with 100% O2 —apply cricoid pressure as needed.2. Prepare equipment: Combitube®, suction, oximeter.3. Place head in neutral position. Open patient’s mouth with jaw lift; Preoxygenate with O2 insert device to markings on tube. Teeth should be between black Tube #1 Tube #2 markings (A).4. Inflate pharyngeal cuff (#1) with 100 mL air (B).5. Inflate distal cuff (#2) with 15 mL air (C).6. Ventilate through longer, A blue tube (#1). Auscultate B lungs and stomach; if lung sounds are present:7. Continue ventilation through C blue tube.8. If gastric sounds are heard (and no lung sounds), ventilate through short, clear tube (#2). Verify lung sounds.9. If lung sounds are present, continue ventilation through short, clear tube #2.10. Secure tube with tape. Reassess airway periodically. Check breath sounds781284041095_CH01_001_005.indd 4 24/04/15 7:17 pm

■■ Interpreting Capnography WaveformsEnd-Tidal CO2 Monitoring (Capnography)Applications Description Wave FormNormal 4 phases, plots CO2 C Dcapnographic concentration over time Ewave form AB = respiratory baseline A B BC = expiratory upstroke CD = expiratory plateau DE = inhalation of CO2- free gasDetect esophageal A flat line occurs; no CO2placement of is detectedET tube duringintubationDetect ET tube When tracheal placementplacement in occurs, exhaled CO2 istrachea shown on capnogram CO2Identify patient’s Movement of patient’sattempt to diaphragm results in a dip in the capnogrambreathe while wave form DipparalyzedRecognize patient Wave form immediatelydisconnection disappears and goes flatfrom mechanicalventilatorPredictor of patient The higher the CO2 the 38outcome higher the cardiac output, and the more effective the 0 resuscitation efforts 5Airway781284041095_CH01_001_005.indd 5 24/04/15 7:17 pm