SKED Podcast 4 - Airway Issues Learned from SMACC DUB

Simple Kind of ED (SKED)

• Reuben Strayer: Leisurely Laryngoscopy (SMACC DUB)

• • Position

  • • head at head of bed, or beyond (occiput off)

    • ear to sternal notch

    • head of bed up

    • • Levitan RM, Mechem CC, Ochroch EA, Shofer FS, Hollander JE. Head-elevated laryngoscopy position: improving laryngeal exposure during laryngoscopy by increasing head elevation. Ann Emerg Med. 2003;41(3):322-30.

    • look into the mouth; not get into the mouth

  • Start laryngoscopy early (but with deliberated slowness)

  • Incremental Goal Directed Tracheal exposure (IGDT)

  • • lead with suction

    • soft palate → uvula → posterior wall → epiglottis → interarytenoid notch

    • ELM (external laryngeal manipulation)

  • Eschmann Introducer (Gum Elastic Bougie)

  • Assistant

  • • 拉嘴角

    • Jaw Thrust Maneuver

    • • Corda, David M., Kevin T. Riutort, Alex J. Leone, Mueez K. Qureshi, Michael G. Heckman, and Sorin J. Brull. "Effect of Jaw Thrust and Cricoid Pressure Maneuvers on Glottic Visualization during GlideScope Videolaryngoscopy." Journal of Anesthesia J Anesth 26.3 (2012): 362-68.

    • 3 Finger Tracheal Palpation

    • • Gamble, Jonathan J. "Three-Finger Tracheal Palpation to Guide Endotracheal Tube Depth in Children." Pediatric Anesthesia Paediatr Anaesth 24.12 (2014): 1312-313.

      • Mckay, William P., Jim Klonarakis, Vladko Pelivanov, Jennifer M. O’Brien, and Chris Plewes. "Tracheal Palpation to Assess Endotracheal Tube Depth: An Exploratory Study." Can J Anesth/J Can Anesth Canadian Journal of Anesthesia/Journal Canadien D'anesthésie 61.3 (2013): 229-34.

• Scott Weingart: Post-Intubation Sedation (SMACC DUB)

• • 止痛先於鎮靜

  • • 1mg hydromorphone ivp, then 0.5mg ivp q10min

    • Neuro problem: choose Fentanyl

  • Scott推薦在急診先用Propofol（Dexmedetomidine生效較慢）

  • Pain cannot be a “pressor”

  • RASS score

  • 使用Rocuronium，請別讓病人流淚！
• dasSMACC: 20170626~0629