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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Sunday, February 7, 2016

Master Tracheal Intubation

ACLS - December 15, 2015
"This year ILCOR examined evidence to determine if one airway is superior to another in terms of survival and neurologic outcome in cardiac arrest. According to the evidence summary “there is inadequate evidence to show a difference in survival or favorable neurologic outcome”, and recommend that the “choice of bag-mask device versus advanced airway insertion, then, will be determined by the skill and experience of the provider”. The clinician must have sufficient initial and continuing education for whatever airway they choose, and must effectively do so while limiting interruptions in quality CPR..."

In summary:

  1. Preparation 
    1. a. Select the right blade size
    2. b. Shape the stylet and ETT straight to the cuff, then bend at a 30-35 degree angle. 
    3. c. Properly position the patient Ear-to-Sternal-Notch with face plane parallel to ceiling.
  2. Epiglottoscopy 
    1. a. Progressively and methodically advance the tip of the blade midline and gently seat in the vallecula. 
  3. Laryngeal Exposure 
    1. a. If the view is still not optimal, consider trying ELM, or HELP to improve visualization. 
  4. Tube Delivery 
    1. a. Using straight-to-cuff shaping, insert near the right corner of the mouth and advance upward. 
    2. b. Pass the tip anterior to the interarytenoid notch. 
    3. c. Ensure the cuff of the tracheal tube is below the level of the cords. 
  5. Tube Confirmation and Maintenance 
    1. a. Direct visualization 
    2. b. Absent sounds over the epigastrium 
    3. c. Equal bilateral breath sounds 
    4. d. Good compliance with the BVM 
    5. e. Tube fogging (never primary) 
    6. f. Continuous waveform capnography (for confirmation and maintenance) 
    7. g. Rising SpO2 (for patients with a pulse)