Excellent Video on Airway Management

[Carlos Danger]

This video on Emergency Medicine Updates is hands down the best educational thing I've seen on the internet on airway management.

Everything in this video is 1000% true. It's all the stuff that I say all the time about airway management, only presented in a more concise, entertaining, and convincing way.

Please watch and discuss!

 

[jrm818]

I really like the chicken wing technique....so obvious now that I've seen it, but I'd never considered it before.

Not sure in the field abandoning the C-hold in favor of thumbs down is possible 100% of the time, but definitely re-enforces the two hand technique as the "oh bugger I just soiled my bloomers" technique of choice (if no SGA).

 

[Akulahawk]

That's absolutely the best video I've seen in a very long time, possibly ever about this subject. I've used the "chicken wing" technique of bagging for quite a while, so that's not new. I've basically used a two handed CE technique for holding the mask to the face and it does work for me. The "thumbs down" method is just another way to accomplish the same thing and it uses more gross motor skill than fine motor skill, which often disappears in the heat of the moment. As to using the LMA, I've trained on it and I like what they can do, I've just never had the opportunity to use one. I still remember how easy it was to place them during training.

 

[Summit]

Nice link... I use both the two thumbs down with the chicken wing and it works great. There are some other good links on that page and from that video!

 

[TheLocalMedic]

I saw this video a few years ago and decided try out the thumbs down grip as well as placing both NPAs and an OPA... It's like magic. I sh*t you not.

I got some weird looks and a little resistance from some people at first, but once they saw how darn effective it is, they reluctantly got on board.

Where I work we do not carry LMAs though, and our only "rescue airway" is the King tube, of which I am not a fan. They tend to cause trauma on insertion, do not seat as well as advertised, slip out of place too easily and some literature now says they put too much pressure on surrounding vasculature, reducing blood flow to the brain. I avoid them at all costs.

 

[Handsome Robb]

Thank you! Awesome video. My hands are small so I've always done the thumbs down hold with the arm squeeze but didn't know it was actually something that was taught. I figured out that's the only way I can get consistently good mask seals and it also makes it kinda difficult to bag way too fast. Definitely possible but more difficult.

 

[Carlos Danger]

I really like the chicken wing technique....so obvious now that I've seen it, but I'd never considered it before.

Not sure in the field abandoning the C-hold in favor of thumbs down is possible 100% of the time, but definitely re-enforces the two hand technique as the "oh bugger I just soiled my bloomers" technique of choice (if no SGA).

No, you are right, there are times in the field where two-handed mask ventilation is impractical or even impossible, and in those cases all you can do is the best you can do. This video was clearly intended for ED physicians who presumably always have someone around to squeeze the bag for them.

Where I work we do not carry LMAs though, and our only "rescue airway" is the King tube, of which I am not a fan. They tend to cause trauma on insertion, do not seat as well as advertised, slip out of place too easily and some literature now says they put too much pressure on surrounding vasculature, reducing blood flow to the brain. I avoid them at all costs.

Unless there is something new out that I'm unaware of, that study was done on pigs. With several studies showing improved or unchanged outcomes in cardiac arrest and trauma victims ventilated with SGA's, I think it's safe to say there is no evidence that SGA's negatively affect cerebral perfusion.

Personally, the more I use LMA's the more I think they are really the way to go in the field.

Thank you! Awesome video. My hands are small so I've always done the thumbs down hold with the arm squeeze but didn't know it was actually something that was taught. I figured out that's the only way I can get consistently good mask seals and it also makes it kinda difficult to bag way too fast. Definitely possible but more difficult.

Carnies. Circus folk. Nomads, you know. Smell like cabbage. Small hands.

 

[DesertMedic66]

Good video. Unfortunately all the times I have needed to ventilate a patient they are in a position or I don't have the man power to do the 2 hand hold.

 

[TheLocalMedic]

Unless there is something new out that I'm unaware of, that study was done on pigs. With several studies showing improved or unchanged outcomes in cardiac arrest and trauma victims ventilated with SGA's, I think it's safe to say there is no evidence that SGA's negatively affect cerebral perfusion.

The swine study was very dramatic, showing markedly reduced cerebral blood flow when the devices were inflated to manufacturers recommended specs (by 15-50%). But I suppose that I'll have to reserve a complete condemnation until there is further research...

As far as SGAs being more beneficial than ETI, there hasn't been any evidence that they are. They simply have the tactical advantage of being easier to insert. In fact, more evidence coming to light suggests that cardiac survival rates are far higher when NO advanced airway is placed.

Additionally, while I have not used an LMA, King tubes have several disadvantages that I listed before that IMO outweigh their supposed ease of use.

 

[Carlos Danger]

The swine study was very dramatic, showing markedly reduced cerebral blood flow when the devices were inflated to manufacturers recommended specs (by 15-50%). But I suppose that I'll have to reserve a complete condemnation until there is further research...

As far as SGAs being more beneficial than ETI, there hasn't been any evidence that they are. They simply have the tactical advantage of being easier to insert. In fact, more evidence coming to light suggests that cardiac survival rates are far higher when NO advanced airway is placed.

Additionally, while I have not used an LMA, King tubes have several disadvantages that I listed before that IMO outweigh their supposed ease of use.

The swine study told us absolutely nothing about the affect of SGA's on human CBF. It didn't even suggest that there is any problem with their use in humans. All it did is point out a theoretical issue that should be looked at further.

Couple important things to keep in mind about this study:

• It was a tiny study (n=9)
  
• It was done on pigs in cardiac arrest...major differences in CBF mechanics during CPR vs. spontaneous circulation. The loss of vascular tone in arrest would predictably make the carotids more compressible than normal.
  
• Pig airway anatomy is substantially different from human anatomy, and the devices used and their recommended inflation volumes for these devices are designed for human airway, not the swine airway
  
• If SGA's actually caused clinically significant decreases in CBF in humans, it would likely be reflected in the dozens of prehospital outcome studies done on SGA's vs.ETI vs. BLS. Most of these studies, however, show very little if any difference.
  
• LMA's are placed probably 10,000 times a day or more in OR's all across the US alone (and are even more widely use in Europe and Asia), and have been extensively studied over the years. There is no known association between LMA use and worsened neurological outcomes. Would that be the case if they caused clinically significant reductions in CBF?

It may be that certain types of SGA's are eventually found to cause CBF decreases in some situations, but my prediction is that even if that is the case, these decreases will be judged clinically irrelevant in light of the substantial advantages presented by LMA's, especially in emergent airway situations. In other words, LMA's will remain the first-line back up airway everyplace but EMS, and EMS will continue doing things the hard way.

 

[mycrofft]

I liked it. It applies to first aiders as well as techs, nurses and docs. Thanks!

 

[Christopher]

This video on Emergency Medicine Updates is hands down the best educational thing I've seen on the internet on airway management.

Everything in this video is 1000% true. It's all the stuff that I say all the time about airway management, only presented in a more concise, entertaining, and convincing way.

Please watch and discuss!

I show this to every one of my EMS classes. Truly an amazing video.

 

[Handsome Robb]

Are you securing the tube? If not you need to be. Ambu/King Systems says they don't need to be secured in a hospital environment but in the prehospital arena they need to be secured. I've had the same issue with them coming out, pop a commercial ETT holder on there and never had an issue.

I had a couple medics tell me that I needed to "hyperinflate" the cuff to get it to stay where I wanted it. I wanted to backhand the both of them.