SKED Podcast 4 - Airway Issues Learned from SMACC DUB

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