Airway Adjunct
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Examples
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Pros
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Cons
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Endotracheal tube introducer |
Gum elastic bougie
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- Higher first pass success when used with direct laryngscope vs. styletted ET tube regardless of whether difficult airway was expected or not[1]
- Can pass blind and confirm tracheal placement with tracheal clicks and hold-up sign
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- Success rates likely depend on operator familiarity with device
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Lighted optical stylets |
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- High success rate - especially good for trauma, c-spine precautions
- Use for both reg and nasotrach
- Lower complication rate
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- Limited by fogging, secretion, recognition of anatomy, cost, and rare provider experience
|
Supraglottic airway |
LMA
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- Easy to place
- Can be placed quickly
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- Does not protect against aspiration
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Esophogeal obturator |
Combitube
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- Good for nurses and paramedics with limited intubation skill
- Indicated if difficult airway predicted: cannot see glottis with laryngoscope
- Reduced risk for aspiration compared to face mask or LMA *Can maintain spinal immobilization
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- Large size predisposes to esophogeal dilatation and laceration as a complication
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Percutaneous transtracheal ventilation
|
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- Prefered over cricothyrotomy in children up to age 10-12
- Oxygenates well
- Can use for 30-45 min
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- Can retain CO2
- May cause pneumothorax or barotrauma
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