intubating a patient who is in cardiac arrest should occur after This is a topic that many people are looking for. star-trek-voyager.net is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, star-trek-voyager.net would like to introduce to you EP5 Intubation during CPR. Following along are instructions in the video below:
Hi. There well you just saw us. Practicing for the airway management.
Can actually stop stop now were just practicing yeah. But were practicing airway management techniques during crisis and so one of the things that we thought wed show you first is the correct way to manage an airway when you have time and its not a crisis. This is not the way to do it and then after that we can kind of see compare and contrast.
How area management and differs. I mean when youre in a crisis. And youre doing chest compressions and in this module.
Were not only going to learn about airway management. Were also going to learn about access whether thats intravenous access or even interosseous access to the patient. Which is also very important during crisis because of course.
Thats the way that you give most of your drugs. So lets get started. Lets take a look at how you can handle airway management in a non crisis situation.
So lets talk a little bit about airway management in a non arrest. Setting. Now this is very different.
The first thing youre going to notice. Is that the bed is of high its almost here at my my bellybutton level. This is because the bed height at this level.
Really helps facilitate and a tracheal intubation for the operator. Obviously. If youre in a code.
Situation compression takes the priority and the bed has to be much lower in order to facilitate the compressor performing chest compressions as you can see kyle demonstrating. Here thats really not possible when the bed is this high. The other thing is youll notice the patient position much more towards the head of the bed in this non arrest situation.
Which you might find you know an elective intubation in the icu for instance is one of these situations. Where the patient is not in arrest is human definitely stable. What requires intubation for some reason also youll notice that the patient is in a sniffing position the flexion and extension of the neck to facilitate an irregular meishan now.
Im not actually gonna take you through all the steps of an a tracheal intubation. Because you know what we know is that if you dont regularly perform endotracheal intubation. You shouldnt be doing it in a code situation.
And there are other techniques that you can use such as laryngeal mask. Airway. X.
or even mask ventilation. Now. Lets actually talk about massive intonation.
This is a very useful technique that can often give you time and bridge the period between apnea and when you can secure the airway. So what we want to do here is to apply the the mask to the patients face starting at the nose and and continue down and tilt down and then with your two finger your fingers here lift up on the jaw and create a seal and sometimes you might have to walk back and forth to get a good seal and then you can go ahead and give a breath. And what you want to do is watch the patients chest rise and fall with each breath.
So that you are confirming that you can ventilate the patient. If you have difficulty there are things that you can do to help facilitate masculine to latian of a patient one of the most common things is insertion of an oral airway you can take an oral airway here and you can insert it into the patients mouth upside down. And then turn it around properly.
And then go ahead and try mask ventilation again and see if that can help you now there are other airways that you can insert as well you can also insert nasal airways. If you insert an oral airway and youre not still getting good ventilation. You can go ahead and lubricate.
A nasal airway and insert that into the patient okay so now. When youre ready you can perform at a tracheal intubation as i mentioned the height of the bed facilitates this were not going to go into all the steps of it today. Thats really beyond the scope of this tutorial.
The key. Though is to really open the mouth widely start from the side and then sweep the tongue out of thewe. Tell people what youre seeing i agreed one view and when you have the great one view dont look up to see where the tube is someone will hand it to you and keep that visualization on the glottic opening and then once that in shriek youll chew is in place.
And the cuff is past the cords. Then you can now remove the stylet you can inflate the cuff and you can have an assistant ventilate. The lungs now how do you confirm and a tracheal intubation.
What you can do is watch for chest rise you can also auscultate the lungs to confirm bilateral breath sounds and most importantly you should check for end tidal carbon dioxide using continuous co2 monitoring and that is airway management in a non rs situation. So now we have the bed set up for optimizing conditions for the compressor during a cardiac arrest situation as you can see the bed position is markedly different than the previous situation where we tried to optimize everything for airway management. And as you can see the beds much lower.
This is so that you can aid the compressor. If you want to demonstrate kyle. How the bed position is now much more optimal for the compressor providing compressions for our resuscitation.
However that comes at the expense of obviously the person managing the airway because theyre now much lower to the floor. The patients not necessarily in the sniffing position not necessarily towards the head of the bed. Lets talk a little bit kyle about optimizing conditions for airway management is it reasonable to pause cpr.
So that we can get the patient into the optimal position for airway management. So we can intubate the patient. It is not this is a big difference from before you should never interrupt compressions to secure an airway.
Let me emphasize this strongly compressions are the priority airway management comes secondary either you you achieve adequate ventilation with bag mask inhalation or you attempt to intubate in the condition that you find the patient or you place a laryngeal mask airway. If you get the patient back. And you get a return a circulation.
Then you can secure the patient airway. The studies show that when people fixate on airway management. They neglect compressions.
They have compressions stopped they reposition the patient they do things that limit and inhibit effective chest compressions now. But i always hear people say abcs. Its airway.
Breathing and then circulation isnt that the same dont those things hold true for cardiopulmonary resuscitation ca b. Now compressions airway breathing. So it has chain thats changed.
Okay and youre often able to get at least marginal ventilation. Which is all you really need is to get a little oxygen in youre not going to try. And really ventilate these patients aggressively.
We already went over that aggressive inhalation is actually detrimental long title. Large tidal volumes. Long and satori holds high respirator eights.
All caused negative performance with your compressions. So less is more do what you can we do have some techniques that we can quickly show you on on how you can improve. Things you can try and bundle a direct laryngoscopy with a pulse check.
But like i said we wont do anything thats not a compressing event to be less than 10 seconds. Its actually pretty hard to intubate someone in less than 10 seconds. And then they got to start they cant wait for you they got to start compressions again as soon as they can so get away from this idea that youre gonna intubate over one in an arrest just figure out how to effectively ventilate the patient so when over bag mask ventilation.
Before and we talked about learned yo mask airway. So i think that thats something to discuss so lets lets recap. A little bit.
If if youre coming to a situation. Where the patient is having a cardiac arrest and compressions are occurring. You should try in terms of managing.
The airway to do bag valve mask bag valve mask mentally. If you can establish ventilation through that method. Then you dont necessarily need to move immediately to a nutricula intubation.
Now. However if you are somebody who does any tracheal intubation on a routine basis. If youre an anesthesiologist or another physician.
Who is comfortable with with performing in a tracheal intubation. It may be reasonable to attempt an a tracheal intubation between compressions. But certainly dont hold chest compressions now if even that expert cannot achieve an a tracheal intubation.
It may be reasonable after a period of mass ventilation to attempt laryngeal mask airway placement. But again to recap certainly dont pause chest compressions dont pause cpr in order to secure the airway and let me just make sure that its clear for our viewers. A laryngeal mask airway is something that you could probably do yourself.
It is not that hard to place. Its actually the data is actually stronger for a more favorable outcome. If you place it early so dont let i dont want to give the sense that this is the last ditch effort.
This is something you know you might want to move to very quickly because it is considered an advanced airway you can then do continuous compressions and only and ventilate. The normal reduce the rates of 6 to 10 breaths with an lma just like an integral. If youre doing bag massive inhalation you still need to coordinate the 32.
So so its 30 chest compressions to positive pressure ventilations. But if you do an advanced airway technique or you are able to secure the airway within a tracheal tube or a laryngeal mask airway. Then you can give breaths during chest.
Compressions. Continuous compressions and the rate and the rate definitely less than 10. I shoot for around 6.
Its actually very hard to do do what the actually average ventilation rate is youre in an arrest higher than that i assure you about 30. You know why its 30. You cant squeeze an ambu bag any faster trust.
Me. This is something thats going to happen people are going to over ventilate you have to watch for it you have to correct your team and you got to make sure they dont get big title because we you know you make them slowed down. But then theyre together give these big title reps.
Its little puffs just to get some oxygen into the patient great well i hope weve given you some tips on airway management. The next thing. Were going to go over is access vascular access.
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