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Obstructed Airway Question

Discussion in 'Scenarios' started by Mike97, Apr 10, 2018.

  1. Gurby

    Gurby Forum Asst. Chief

    I got to do one on a cadaver and it was surprisingly easy. I feel like as long as you stay midline you probably can't really screw it up too badly. If you hit the thyroid cartilage just move down a bit and keep trying.

    CANMAN Forum Asst. Chief

    I have been fortunate, or I guess unfortunate enough to have 2 surgical airways under my belt. One medical scenario and one trauma, performed with a different technique each time with the second one being dictated by my medical director's (at the time) preferred method. Honestly, there is some blood, but it's not a blood bath as some make it out to be. As long as you stay midline and away from the vascular structures that run parallel to midline you're all good. An open surgical airway is a procedure that is done all by feel, or at least should be, so blood obscuring your visualization shouldn't be a worrying factor. As stated here the biggest difficulty is just mentally committing to the procedure itself. Once executed it's an easy day, you have likely just saved a life, and the minor bleeding is easily controlled with 4x4's cut into trach sponges with scissors. Hold them in place as you hold the tube for the duration of the transport.

    Given a known airway obstruction in the unconscious patient, that I can't visualize using DL and remove with Magill forceps or dislodge with CPR, I'm absolutely resorting to a surgical airway as a last ditch otherwise the patient is priority 4.
    Gurby likes this.
  3. medichopeful

    medichopeful NRP, ICU RN, CCRN, CEN

    ^This. Our protocol is 1 attempt at intubation -> 1 attempt with Magills -> surgical crich.
    Gurby likes this.
  4. RocketMedic

    RocketMedic Fancy Book Learnin'

    Critical Care EMT-P
    No one should suffocate without a hole in their throats
  5. Rommel

    Rommel Forum Ride Along

    Yes, Australia (and I believe NZ) uses back blows and or chest thrusts to dislodge. If pt is unconscious a laryngoscope and forceps are used to remove obstruction. Given the relative size of the glottis it is assumed that a body small enough to be sucked through will likely be small enough to be blown down the 4" of trachea to allow access to at least one side of the lung or allow air to flow by the obstruction lodged within the trachea. You run into problems if these assumptions are incorrect or clumsy use of forceps forces the body (or part of it) through the glottis and into the upper trachea making it very difficult (or impossible) to get a purchase on. The BVM allows a degree of high pressure to move the body in worst case scenario but is not without obvious secondary risks to airway via barotrauma and aspiration of stomach contents post possible aggressive ventilation.

    I think maybe cric has a place if vocal cords are unable to be visualised and therefore no sight of the obstructive body was possible. What I don't like about the Australian protocol is that there is a risk that the body, which may otherwise be removed with dextorous use of forceps, may be shifted through the vocal cords if one resorts to the BVM too quickly. But that is the world we live and work in. Thankfully I have not had to make this decision... yet.

    Airway world was informative, thanks guys!

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