Needle cricothyrotomy can provide adequate oxygenation, but not adequate ventilation. Avoid using for greater than 45 minutes.
If a commercially available kit is not available, you can use a 12-14 gauge angiocatheter connected to 3-mL syringe with the plunger removed. This will allow you to connect a 6.5 mm endotracheal tube and ventilate via BVM
The “Scalpel-Finger-Bougie” technique has the benefit of speed and simplicity, as it does not require any specialized equipment
Identifying and marking cricothyroid landmarks with a pen prior to the initial incision has been shown to be unreliable for accurate placement, though it does have the benefit of mentally preparing the clinician and team for the possibility of a surgical airway option if intubation fails.
Form of indirect laryngoscopy utilizing a rigid transoral video device, most commonly the Airtraq, C-MAC, or Glidescope.
Blade shapes for video laryngoscopy are either standard-geometry blades (SGVL) or hyperangulated blades (HAVL), both requiring different techniques.
Any patient meeting criteria for endotracheal intubation.
Generally preferred over direct laryngoscopy in patients with difficult anatomy.
No absolute contraindications
Relative contraindications include need for foreign body removal, blood/emesis in airway.
Camera contamination w/ blood or emesis in airway
Screen failure (hyperangulated blades will not allow for direct view if video malfunctions)
When using a hyperangulated blade, the goal is to achieve a “sub-optimal” view of the vocal cords prior to insertion. Getting too close and achieving full visualization means displacing the eppiglottis, which whill obstruct your intubation attempt.
Using a Bougie can be a great way to maximize first pass success, though users may find it difficult to navigate it around airway structures while using a hyperangulated blade.
Tidal volume settings should be set to “ideal” body weight, instead of actual body weight, to avoid hypo/hyperinflation.
A good starting point for mechanical ventilation after intubation is Volume Control (6-8mL/kg ideal body weight, RR 16-22, FiO2 100%, and PEEP 5). The settings can be adjusted based on ABG’s and clinical response.
Also known as “extraglottic airways”. These devices are inserted through the oropharynx to provide temporary airway ventilatory management, without passing the vocal cords. Common brands include the laryngeal mask airway (LMA), King Airway, and I-Gel.
Commonly used as a rescue device after failed intubation attempts, but may also be useful as a conduit for intubation or first-line for prehospital cardiac arrest.
Ineffective placement, aspiration of gastric contents, pharyngeal edema
I-Gel airways have the advantage of not requiring additional inflation once inserted.
Although supraglottic airway devices offer some barrier from gastric contents, as well as ports for gastric decompression tubes, it cannot definitively protect the airway from aspiration like an endotracheal tube can.