Podcast #109 – Tips to Manage the Contaminated Airway with Jim DuCanto

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It has been 100 podcasts since the last time Jim DuCanto talked about his SALAD (Suction Assisted Laryngoscopy Airway Decontamination) technique.  Podcasts #8 and #9 were so long ago we wanted to have Jim back on to celebrate his achievements and talk more about the future of SALAD and other related projects.
First, apologies for some audio quality issues.  During the editing, as much of it was cut out as possible but we did have to keep some of it based on the actual talk.  However, here are some of the key points we discussed when it comes to managing difficult contaminated airways so you can do the basics well:

  • Have suction ready
    • Speak softly, but carry a big stick
      • Jim has made his own suction device
      • There are other great options out there, but the key is a large diameter
      • Unlike others, Jim’s lacks a vent hole and is better curved for VL devices
    • Avoid Yankauer suctions – it is not meant to be used with heavy airway contamination
    • In a pinch, you can use suction tubing alone but it is not as easy to control
  • In basic contaminated airway management do the following:
    • Decontaminate the oropharynx first
    • Use the suction as a tongue blade to introduce the bleed
    • Decontaminate the hypopharynx
    • Place tube in the larynx 
  • If the vomiting will not stop, tube the goose (intentional esophageal intubation)
    • Proceed as you otherwise plan with a second endotracheal tube
    • You do not need to put the esophageal tube on suction (but watch for contents)
  • With two suction devices, you can use an assistant for better visualization and management
    • Assistant approaches from the right and assists in suction of the hypopharynx
    • They then move their suction to the right corner of the mouth
    • The goal is to open up the airway to be highly visible and easier to visualize the pharynx
    • Assistant is also immediately there to further assist in suctioning as needed
  • Learn how to do SALAD and practice!
    • Check out these four videos for details: #1, #2, #3, #4
    • Also learn how to make your own or buy one: Make your own #1 or #2
  • Learn to do the crab when intubating
    • Picture and video below to show technique
    • Now Jim’s usual approach to patients
    • Great when patient is at a height taller than you such as with ramping or large patients
    • Can also be beneficial when they are upright such as awake intubations
    • This technique can be applied in prehospital environments such as extrication
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