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Airway Management

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Mahmoud Saghaei

on 18 November 2012

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Transcript of Airway Management

Airway Management Miller, Chapter 50 Paralytic Agent of Choice Anatomy & Physiology Core assessment:
Moth opening
Jaw protrusion
Head extension Sux: 1 mg/kg, 40 - 60 seconds, 10 minutes
bradycardia, cardiac arrest, hyperkalemia, fasciculations, increase O2 consumption, muscle pain, ^intra-gastric pressure, ^lower esophageal sphincter tone, ^intracranial and intraocular pressure, MH, Sux apnea, masseter muscle regidity
1. hyperkalemia
2. risk of hyperkalemia: renal failure, severe sepsis, congenital myopathies, neuromuscular disorders such as tetanus and botulism, upper motor neuron disorders (stroke >72h, motor neuron disease, mutliple sclerosis, spinal cord injury >72h), burns > 72h, crush injury
3. malignant hyperthermia
4. suxamethonium apnoea Rocuronium: vecuronium analogue, hepatic/ biliary and urinary excretion, 0.6 - 1.2 mg/kg, 40 - 60 seconds (1.2 mg/kg), 90 minutes, can be reversed in about 2.2 minutes with 16 mg/kg IV sugammadex
Side effects: sNone
Contra-indications: None Sux vs Roc:
safe apnoea time (SaO2 93%) 40 seconds longer with roc
But roc lasts very longer
Is that a bad thing ??? Other tests:
Pronatic ability
Dentitions DMV:
Limited mandibular protrusion, abnormal neck
anatomy, sleep apnea, snoring, obesity, Beardedness,
thyromental distance
No test for prediction of no mask ventilation
(prevalence as low as 0.07%) serious airway morbidity, though infrequent, is a much worse outcome than performing an awake intubation that might not have been necessary. Upper Airway Obstruction
1. soft palate (velopharynx)
2. epiglottis
3. tongue HT ± JT ± Lt
PEEP / CPAP Sux case: a dif case, and you failed
The patient is waking up and become
agitated, difficult to bag, desaturating,
you have lost control on the airway and
head position. Urge to redose sux,
lots of secretion, late for atropine,
bradycardia on redose ... Roc case: same as sux but they are still completely paralyzed as you bag them and reattempt. Roc rocks
Sux sucks Laryngospasm Preoxygenation
Denitrogenation DAWD How many breaths? O2 via NC:
3-6 LPM when awake
15 LPM when obtunded Mahmoud Saghaei Expiration:
Air: 16% O2
O2: 95% O2
Where is oxigen reserve?
How preoxygenation works?
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