0071643192.pdf

PROCEDURE

■ Administer local airway anesthetic.

■ Options include nebulized or atomized 4% lidocaine and topical benzo-

caine gel to base of tongue.

■ Sedate to blunt airway reflexes.

■ Ketamine (10–20 mg/dose): Muscle tone is maintained.

■ Perform direct laryngoscopy and intubation once sedated.

■ Confirm placement.

FIBEROPTICAWAKEINTUBATION

INDICATION

■ Spontaneously breathing patient with an anticipated difficult airway

■ Suspected laryngeal abnormalities

■ Poor mouth opening

CONTRAINDICATIONS

■ Copious blood or secretions

■ Inadequate oxygenation or ventilation (because of time required for

procedure)

PROCEDURE

■ Anesthetize nasal and/or oral mucosa as with awake intubation.

■ Nasopharyngeal approach is preferred.

■ Easier angle of insertion

■ More defined path of insertion

■ Better tolerated by patient

■ Insert scope “loaded” with ET tube and advance through cords under direct

visualization.

■ Advance ET tube.

■ Confirm placement.

BLINDNASOTRACHEALINTUBATION

INDICATIONS

■ Spontaneously breathing patient with an anticipated difficult airway

CONTRAINDICATIONS

■ Pediatric patient <10 years old

■ Midface trauma or basilar skull fracture

■ ↑intracranial pressure

■ Anticoagulation or anticipated need for thrombolysis

■ Combative patient

■ Apnea

PROCEDURE

■ Preoxygenate.

■ Administer nasal anesthetic and vasoconstrictor.

■ Administer nasal lubricant.

■ Insert ET tube with bevel away from septumand gently advance until

breath sounds are heard best through tube.

RESUSCITATION

The nasal approach is better

tolerated than the oral

approach in fiberoptic awake

intubation.

Blind nasotracheal intubation

cannotbe performed on the

apneic patient.