Anaesthetized patient who cannot be ventilated or intubated
- Laryngeal mask airway
- Combitube
- Transtracheal jet ventilation
- Surgical airway
cricothryotomy, minitracheostomy, tracheostomy
Improve Ability to Ventilate
- Better patient positioning
- Jaw thrust
- Guedel airway
- Nasopharyngeal (although run risk of producing bleeding in already difficult situation)
- Apply mask with two hands and give reservoir bag to assistant
- Laryngeal mask (LM) or Intubating laryngeal mask (ILM)
- Surgical Airway
DIFFICULT MASK VENTILATION
Try:
- appropriately sized face mask
- oropharyngeal & nasopharyngeal airways
- holding mask with both hands, 2nd person to squeeze reservoir bag
- high fresh gas flow +/- continuous application of oxygen flush
POOR LARYNGOSCOPIC VIEW
Consider:
- release of cricoid pressure (may be distorting view)
- come out & re-position patient
- use of gum elastic bougie
- alternate laryngoscope (eg Bullard) or blade (eg different size, McCoy or straight)
- fibreoptic intubation if skilled
Difficult ventilation & failed intubation:
- LMA (more people are familiar with this)
- Combitube
- Both can be inserted blindly to establish an airway
CAN’T VENTILATE, CAN’T INTUBATE
Direct route into airway must be established:
Cricothyroidotomy
Tracheostomy
St. Vincent's Hospital Melbourne. Department of Anaesthesia. ©2003
