Episode 29: Why We Mismanage Airways with Jayson McConnell

Airway Pic

Listen here or download on iTunes, Podcast Addicts, or Podcast Republic. 

Our thanks to Jayson McConnell for stopping in and sharing his great thoughts on airway management. We have been content as a field with teaching poor techniques for managing airways, and it’s high time we stop propagating the bullshit.

Getting the BLS Airway Management Right

  • It all starts with positioning!
    • A slight increase of 20-30° can prevent airway contamination from vomit.
    • Creates better alignment with airways providing for more natural ventilation.
  • PEEP
    • Use it whenever you are using a BVM.
    • Intrinsic PEEP levels for spontaneously breathing individuals is typically between 3-5cmH20.
    • BVM with no PEEP valves provides no PEEP at all.
    • The fear of low PEEP settings and regular tidal volumes is unfounded.
    • PEEP decreases V/Q mismatch and improves alveolar shunt.
  • BVM Manometers
    • Without these devices, there is no practical way to estimate how much tidal volume is actually being delivered with each breath.
    • 9/10, the least experienced person is bagging the patient and providing way too much tidal volume and no PEEP. By doing this, we can damage lung physiology, while simultaneously not increasing our oxygen delivery.
    • Average adults need around 450-500ml for a normal tidal volume; most BVMs range from 2-3 times that… why are we still using this method?
  • Seal
    • EC clamp does not work… so don’t use it!
    • One person cannot effectively use a BVM!
    • T Clamp can work, but absolutely requires two people.
    • What about using a CPAP mask in lieu of standard mask?

Comparison of Preoxygenation Strategies

  • Standard BVM:
    • No PEEP and poor tidal volume control
  • Standard BVM with High Flow Nasal Cannula:
    • No PEEP and poor tidal volume control, but possibly improved FiO2
  • BVM with attachments and High Flow Nasal Cannula:
    • Improved V/Q mismatch, improved alveolar opening and gas exchange, improved FiO2.
  • Apneic CPAP Preoxygenation:
    • Adjustable PEEP settings that are easily controlled with improved V/Q mismatch, improved alveolar shunt, and improved FiO2.
  • Ventilator/Mask Combination for Preoxygenation:
    • Adjustable PEEP settings that are easily controlled with improved V/Q mismatch, improved alveolar shunt, and improved FiO2.
    • Takes away human factor components and provides consistent tidal volume and ventilation rate.

Improper Airway Management Demonstration

Proper Airway Management Demonstration

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