Learn Airway management in ICU and Emergency Department in less than 30 min

Introduction

This tutorial focuses on airway management in the Intensive Care Unit (ICU) and Emergency Department (ED), based on the insights from Dr. Ravindra of the Institute of Emergency Medical Sciences. Proper airway management is critical for the survival of patients in these settings. This guide provides a step-by-step approach to effectively manage airways, ensuring safety and efficiency in critical situations.

Step 1: Assess the Airway

• Identify the patient's condition: Determine if the patient is breathing adequately. Look for signs of respiratory distress, such as:

  • Abnormal breathing patterns
  • Cyanosis (bluish skin)
  • Use of accessory muscles

• Evaluate airway patency: Check for any obstructions:

  • Foreign objects
  • Swelling or trauma
  • Secretions or vomit

• Use a basic airway assessment tool: Consider the "LEMON" mnemonic:

  • Look externally
  • Evaluate 3-3-2 rule (3 fingers for mouth, 3 for jaw, 2 for neck)
  • Mallampati score (classify airway visibility)
  • Obstruction (check for possible blockages)
  • Neck mobility

Step 2: Position the Patient

• Optimal positioning: Position the patient to facilitate easier airway management:

  • Place the patient in a supine position (lying on their back).
  • If possible, elevate the head slightly to open the airway.

• Use the sniffing position: Tilt the head back and slightly elevate the chin to align the airway.

Step 3: Clear the Airway

• Suctioning: If there are secretions or vomit, use a suction device to clear the airway.

  • Use a sterile suction catheter to avoid introducing bacteria.
  • Suction only as needed to reduce trauma and irritation.

• Manual airway maneuvers: If necessary, use the chin lift or jaw thrust techniques to open the airway.

Step 4: Provide Supplemental Oxygen

• Administer oxygen: Use a non-rebreather mask or nasal cannula to provide high-flow oxygen to the patient.
• Monitor oxygen saturation: Keep an eye on the patient's oxygen levels using a pulse oximeter.

Step 5: Prepare for Advanced Airway Management

• Equipment readiness: Ensure that all necessary equipment is ready for intubation if required:

  • Endotracheal tubes (ETT)
  • Laryngoscope
  • Bag-valve-mask (BVM) device
  • Suction device

• Pre-oxygenate the patient: Use a BVM to provide high-flow oxygen for 3-5 minutes before intubation.

Step 6: Intubation Process

• Select the correct ETT size:

  • For adults, typically 7.0-8.0 mm internal diameter for females and 8.0-9.0 mm for males.

• Perform intubation:

  1. Pre-medicate the patient if indicated (consider sedatives and paralytics).
  2. Use the laryngoscope to visualize the vocal cords.
  3. Insert the ETT through the vocal cords into the trachea.
  4. Inflate the cuff of the ETT to secure the airway.

• Confirm placement:

  • Use auscultation to check for bilateral breath sounds.
  • Observe end-tidal CO2 levels if available.

Step 7: Monitor and Secure the Airway

• Secure the ETT: Use tape or a commercial tube holder to secure the ETT in place.
• Continuous monitoring: Keep monitoring the patient's oxygen saturation and vital signs.

Conclusion

Effective airway management is crucial in the ICU and ED settings. By following these steps—assessing the airway, positioning the patient, clearing obstructions, providing oxygen, preparing for advanced management, and intubating when necessary—you can significantly improve patient outcomes. Always remember to remain calm and methodical in critical situations. Regular practice and familiarity with equipment will enhance your skills in airway management.