Advanced Life Support
Airway management
- Supplemental oxygen
- Facial mask
- Self inflating bag
- Simple airway adjuncts: oropharyngeal airway
- Simple airway adjuncts: nasopharyngeal airway
- Tracheal tube
- Laryngeal mask airway
- Combitube
- Magill forceps
- Laryngoscope
- Cricotiroidotomy kit
- Large bore suction catheter (Yankauer)
- Vacuum cleaner
Tracheal intubation in advanced life support
Laryngoscopy and intubation of the trachea should not last longer than 30 seconds. Any doubt about the correct placement of the tube in the trachea leads to tube withdrawal and re-oxygenating the patient before further attempts.
Tracheal intubation advantages
- Allows ventilation with up to 100% oxygen
- Isolates airway, preventing aspiration
- Allows suction of the airway
- The release of a resuscitation team member
Tracheal intubation limitations
- Training and experience essential
- Failed insertion
- Could worsen cervical or head injury
Confirming correct placement of a tracheal tube
- Direct visualisation at laryngoscopy
- Ascultation (bilaterally, mid-axillary line, over the epigastrium)
- Symmetrical movement of the chest during ventilation
- Capnometry (recording the carbon dioxide concentration of exhaled air at the patient's airway using a capnometer)
Tracheal intubation - accidents, incidents
- Dental fractures
- Vomiting and regurgitation
- Trismus (spams of the jaw muscles)
- Oesophageal intubation
- Cervical spine lesions
Sellick maneuver - Cricoid pressure
The application of pressure to the cricoid cartilage of the neck and consequently blocking the oesophagus which passes directly behind it.
Needle cricothyrotomy in advanced life support
Indicated in case of failure to provide an airway by any other means
Complications
- Incorrect position of the cannula
- Emphysema
- Haemorrhage
- Oesophageal perforation
- Hypoventilation
- Barotrauma (change in air pressure affecting the ear or lung)
Ventilation in advanced life support
- Mouth to mask ventilation
- Self inflating bag
- Supraglottic airways: laryngeal mask airway LMA
- Supraglottic airway: i-gel
- Supraglottic airway: laryngeal tube
- Ventilators
