BMV: bag-valve mask; CP: cricoid pressure; DA: difficult airway; DL: direct laryngoscopy; FIS: flexible intubation scope; FSI: flexible scope intubation; GA: general anesthesia; LMA: laryngeal mask airway; MILS: manual in-line stabilization; RSI: rapid sequence intubation; SGA: supraglottic airway; VAL: video-assisted laryngoscopy; ASA: American Society of Anesthesiologists.
* Confirm ventilation, tracheal intubation or SGA placement with standard confirmatory techniques (exhaled CO2, misting of tube, auscultation of breath sounds, improving SpO2). If perfusion (and exhaled CO2) absent, use additional confirmation methods (eg, repeat laryngoscopy, bronchoscopy, esophageal detector device, chest radiograph).
¶ Other options in ASA algorithm:Δ Invasive airway access includes surgical or percutaneous cricothyrotomy or tracheostomy, transtracheal jet ventilation and retrograde intubation.
◊ Emergency non-invasive airway ventilation consists of SGA.
§ Aborting the case and awakening the patient to optimize and re-attempt intubation via a different airway technique (eg, awake intubation) is impractical in most trauma cases due to the emergent condition of the patient.
¥ Alternative difficult intubation approaches include (but are not limited to): VAL, SGA (eg, LMA as an intubation conduit with or without flexible scope guidance), flexible scope intubation, intubating stylet or tube changer, and light wand. Blind intubation (oral or nasal) is discouraged in patients with maxillofacial trauma and laryngeal or tracheal injury.
‡ Surgical airway kit should be immediately available.Do you want to add Medilib to your home screen?