Difficult Airway

Anatomy of the ET Tube

EMKF

⏺ 15 mm connector – standardized on all airway equipment to avoid a situation where somebody had to look for the right adaptor

⏺ Pilot balloon – contains a spring-loaded one way valve to inflate the balloon.

⏺ One way valve – prevents the air from leaking out when the syringe is disconnected

⏺ Inflatable cuff – has 2 purposes: seals the trachea so that 1) positive pressure can’t escape from lower airways, and 2) seals the trachea so patient doesn’t aspirate any secretions or stomach contents coming from upper airway

⏺ Magill Curve – a natural curvature of approximately 140mm radius, +/- 20mm

⏺ Black line – suggested vocal cords marker

⏺ Size of the ETT – is the internal diameter of the tube

⏺ Depth markings – allow us to measure the depth of the ETT at the teeth or lips (typically 3x size of ETT)

⏺ Radio-opaque line (white here, but I’ve also seen blue!) – helps with the identification of the ETT on X-ray

⏺ Murphy’s Eye – an opening on the right side that allows for ventilation, if the primary opening gets occluded.

Difficult Airway

EMKF
  • MOANS – difficult BVM
  • LEMON – difficult laryngoscopy
  • The Two Minute Drill: How I Prep My Airways
  • The Bloody Airway: The Trauma Airway and the GI bleeder
  • The Obstructed Airway: Angioedema and Deep Space Infections

Inhalational Injury

EMKF

Classically, the diagnosis of inhalation injury was subjective and made on the basis of clinical findings. Pertinent information includes exposure to flame, smoke, or chemicals (industrial and household), duration of exposure, exposure in an enclosed space, and loss of consciousness or disability. Pertinent physical exam findings include facial burns, singed facial or nasal hair, soot or carbonaceous material on the face or in the sputum, and signs of airway obstruction including stridor, edema, or mucosal damage. Older patients, and those with more extensive burns, are at increased risk of inhalation injury because of prolonged exposure to the fire environment.

Which tongue lacerations do I need to repair?

EMKF

You should repair those that cause problems with breathing, speech and/or gustation/swallowing:

  • Bisect the tongue extending through the free edge – creating the “snake” look
  • Have large mobile flaps or U-shaped defects (>1-2cm)
  • Won’t stop bleeding
  • Are avulsion or amputation injuries – which may require a surgeon (ENT, OMFS etc.) if complex.