Airway Management in the Emergency Department and ICU is a set of slides available online that efficiently review the subject in 47 slides. (1)
I’ll review a few of the slides, but it is worth going through the entire lecture.
Slide 5: Oxygen Delivery Devices (in order of degree of support)
4% increase in FIO2 for each one liter of flow (e.g. 4 liters of flow = 37% or 6 liters of
flow = 45%
At most delivers 40% at 10-15 liters of flow
Small amount of rebreathing
8 liters of flow = 40%, 15 liters of flow = 60%
Attatched reservior bag allows 100% to enter mask with inlet/outlet ports to allow exhalation to
escape—does not guarantee 100% delivery [delivered % is much less than 100%]
Slide 6: Oxygen Delivery Devices (Noninvasive Positive Pressure)
CPAP is a continuous positive pressure
Indicicated in hypoxic respiratory failure and obstructive sleep apnea
BIPAP allows for an inspiratory and expiratory pressure to support and improve spontaneous ventilation
Mainly indicated in hypercapnic respiratory failure and obstructive sleep apnea
If use of noninvasive modes of ventilation does not result in improved ventilation or oxygenation in two or three hours,intubation should be considered.
These devices can be used if the following conditions are met:
Patient is cooperative with appropriate level of consciousness
Patient does not have increased respiratory secretions or aspiration potential
Concurrent enteral feeding is contraindicated
Facilitates early extubation, especially in COPD patients.
Some devices allow respiratory rate to be set.
Up to 10 liters of oxygen can be delivered into the mask for 100% oxygen delivery
Nasal or oral (full face) mask can be used. Less aspiration potential with nasal.
Slide 7: Degree of Respiratory Distress
Accessory muscle use is an indication of distress
Respiratory rate of greater than 30 can indicate need for more support by noninvasive positive pressure or intubation
Need for artificial airway
Tongue and epiglottis fall back against posterior pharyngeal wall
Nasopharyngeal airway better tolerated.
O2 saturation less than 92% on 60 to 100% oxygen can suggest the need for intubation based on whether there is anything immediately reversible which could improve ventilation.
Arterial blood gas
ph of less than 7.3 can indicate the need for more respiratory support by noninvasive positive pressure or intubation
(1) Airway Management in The Emergency Department and ICU. The Resident ICU Course from the Society of Crtical Care Medicine, 2008. Available at