0071643192.pdf

■ Sizing

■ Premature infants: Size 0

■ Normal infants: Size 1

■ Older children: Size 2

■ Adults: Size 3–4

BAG-VALVEMASK

A BVM with reservoir bag (to increase delivered O 2 ) is essential for airway

management.

For pediatrics:

■ Should have a minimum volume of 450 mL

■ Pop-off valves should be avoided (pressures required to ventilate are often

higher than the pop-off threshold).

ENDTIDALCO 2 (ETCO 2 ) DETECTOR

Detecting ETCO 2 (yellow color change or 5% CO 2 ) after six manual breaths

is the 1°means of confirming ET tube placement.

■ False-positive ETCO 2

■ May occur if tube is in the supraglottic region, with gastric distention

or immediately following sodium bicarbonate administration

■ Indeterminate or false-negative result

■ May occur in patient with poor pulmonary perfusion (cardiac arrest,

massive pulmonary embolism [PE])

■ Level> 2% (tan or yellow) = correct placement in cardiac arrest

■ No ETCO 2 →tube could be anywhere!

GUMELASTICBOUGIE

■ Helpful when only arytenoids are seen or cord opening is narrow

■ Secures a path into the trachea, over which an ET tube can be guided in

A 23-year-old male arrives to the ED via EMS after having a witnessed

seizure at home. On examination, he is lying supine on the stretcher and

has sonorous respirations with loud upper airway noises during inspira-

tion. What is the first step in managing this patient’s airway?

This patient likely has an upper airway obstruction from his tongue falling

back against his posterior pharynx. The first step is to perform a chin-lift and jaw-

thrust maneuver, which will relieve the obstruction. This can be followed by

nasopharyngeal (not oropharyngeal) airway placement.

BASICAIRWAYPROCEDURES

OROPHARYNGEAL ANDNASOPHARYNGEALAIRWAYPLACEMENT

Thetongueis the most common cause of upper airway obstruction in the

supine unconscious or semiconscious patient.

RESUSCITATION

ETCO 2 should be confirmed

aftersixmanual breaths.

False-negative ETCO 2 may

occur with low pulmonary

perfusion states (massive PE,

cardiac arrest).