22-07: Oropharynx And Airway Decontamination Strategies

Clinical Summary

Hematemesis (see Video 22.6), emesis (see Videos 22.7 and 22.8), and oropharyngeal bleeding (see Videos 22.9 and 22.10) during intubation increase the probability of aspiration and its complications. Having a strategy for active vomiting and bleeding during intubations is prudent to prevent or lessen the volume of aspirated vomitus.

Possible Strategies

1. Place the patient in reverse Trendelenburg position to use gravity to prevent further vomiting (see Fig. 22.34).

2. Perform deliberate esophageal intubation to direct emesis away from the oral cavity (see Fig. 22.35).

3. Use a large-bore DuCanto suction catheter rather than a Yankauer (see Fig. 22.36).

4. Use the suction-assisted laryngoscopy and airway decontamination (SALAD) technique.

   1. Lead with suction during laryngoscopy (see Fig. 22.37).

   2. Decontaminate the oropharynx (see Fig. 22.38).

   3. Follow the suction with direct laryngoscopy or video laryngoscopy (see Fig. 22.39).

   4. Visualize the epiglottis and vallecula (see Fig. 22.40).

   5. Decontaminate the larynx.

   6. If repeated soilage, place the suction catheter to the left of the laryngoscope for continuous decontamination during tube passage (see Fig. 22.41).

   7. Place ETT and remove stylet.

   8. Suction the ETT (see Fig. 22.42).

   9. Begin ventilation.