Current Topics in Airway Management: Mechanical Ventilation, Supraglottic Airway Devices, and Intubating Patients With COVID-19

This course combines video, audio, and digital components to review ventilator management for adult patients, mechanical ventilation and supraglottic airway devices for pediatric patients, and intubation of COVID-19 patients. Includes 13.5 AMA PRA Category 1 Credits™.

Modules

Module 1: Ventilator Management of Adult Patients in the Emergency Department + two-part EMplify podcast audio discussion
Module 2: Mechanical Ventilation of Pediatric Patients in the Emergency Department
Module 3: Supraglottic Airway Devices for Pediatric Airway Management in the Emergency Department
Module 4: Intubating a Patient With COVID-19 (Video)

We hope you enjoy this course! If you have any questions, our Customer Service Team is here to help Monday - Friday, 9:00am-5:30pm EST, and can be reached at 678-366-7933 or ebm@ebmedicine.net

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Authors

Ryan Pedigo, MD

Director, Medical Student Education, Harbor-UCLA Medical Center; Assistant Professor of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA

Casey Carr, MD

Critical Care Fellow, University of Florida Shands, Gainesville, FL

Courtney W. Mangus, MD, FAAP

Clinical Lecturer, Departments of Emergency Medicine & Pediatrics, The University of Michigan, Ann Arbor, MI

J. Kate Deanehan, MD, RDMS A

Assistant Professor, Pediatric Emergency Medicine, Johns Hopkins Children’s Center, Baltimore, MD

Jennifer E. Sanders, MD, FAAP

Assistant Professor, Departments of Pediatrics and Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Louis A. Spina, MD, FAAP

Assistant Professor, Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY

Peer Reviewers

William A. Knight, IV, MD, FACEP, FNCS

Associate Professor of Emergency Medicine and Neurosurgery, Medical Director, EM Advanced Practice Provider Program; Associate Medical Director, Neuroscience ICU, University of Cincinnati, Cincinnati, OH

Charles Stewart, MD, EMDM, MPH

Emergency Physician; Tulsa, OK; Visiting Professor, European Master Disaster Medicine Program

Nicole Gerber, MD

Assistant Professor of Clinical Pediatrics, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY

Garrett S. Pacheco, MD

Assistant Professor, Residency Associate Program Director, EM and Combined EM & Pediatrics, Departments of Emergency Medicine and Pediatrics, University of Arizona, Tucson, AZ

Heather M. Kuntz, MD, FACEP, FAAP

Associate Program Director, Pediatric Emergency Medicine Fellowship, Loma Linda University, Loma Linda, CA

Shira A. Schlesinger, MD, MPH, FACEP

Director, EMS & Disaster Preparedness Programs; Associate Director, EMS Fellowship, Harbor-UCLA Medical Center, Torrance, CA

Podcast Presenter

Sam Ashoo, MD

Emergency physician practicing in Tallahassee, FL; board-certified in emergency medicine and clinical informatics

Video Presenter

Calvin A. Brown III, MD

Vice Chair for Network Development, Associate Professor of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA

Product Details

Publication Date: December 9, 2020

CME Expiration Date: July 1, 2023

CME Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME. Credit Designation: EB Medicine designates this enduring material for a maximum of 13.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Current Topics in Airway Management: Mechanical Ventilation, Supraglottic Airway Devices, and Intubating Patients With COVID-19 is eligible for 13.5 Category 2-A or 2-B credit hours by the American Osteopathic Association. The “Ventilator Management of Adult Patients in the Emergency Department” journal issue is approved by the American College of Emergency Physicians for 4 hours of Category I credit. The “Mechanical Ventilation of Pediatric Patients in the Emergency Department” journal issue is approved by the American College of Emergency Physicians for 4 hours of Category I credit, and has been reviewed by the American Academy of Pediatrics and is acceptable for 4 AAP credits. The “Supraglottic Airway Devices for Pediatric Airway Management in the Emergency Department” journal issue is approved by the American College of Emergency Physicians for 4 hours of Category I credit, and has been reviewed by the American Academy of Pediatrics and is acceptable for 4 AAP credits.

Module 1: Ventilator Management of Adult Patients in the Emergency Department + two-part EMplify podcast audio discussion

Abstract
Case Presentations
Introduction
Critical Appraisal of the Literature
Prehospital Care
Approach to Initial Ventilator Settings
1. Modes of Ventilation
  1. Volume Assist-Control Mode
  2. Pressure-Regulated Volume Control
    - Tidal Volume
    - Inspiratory Peak Flow Rate (Inspiratory Time)
    - Respiratory Rate
    - Positive End-Expiratory Pressure
    - Fraction of Inspired Oxygen
    - Inspiratory to Expiratory Time (I:E Ratio)
2. Other Modes of Ventilation
  1. Synchronous Intermittent Mandatory Ventilation With Pressure Support
  2. Airway Pressure Release Ventilation
3. Oxygen Delivery
Approach to Specific Types of Patients Requiring Mechanical Ventilation
1. Obstructive Physiology (Asthma and Chronic Obstructive Pulmonary Disease)
2. Acute Respiratory Distress Syndrome
  1. Use of Paralytic Agents in ARDS
  2. Recruitment Maneuvers in ARDS
  3. Prone Positioning in ARDS
  4. Nontraditional Ventilator Settings in ARDS
3. ARDS and Coronavirus Disease Infection
4. Severe Metabolic Acidosis
Monitoring and Making Changes to the Ventilator Settings
1. Arterial Blood Gas
2. Pulse Oximetry
3. Waveform Capnography
4. Ventilator Pressures
5. Assessing for Breath-Stacking
Special Populations
1. Obese Patients
Controversies and Cutting Edge
1. Extracorporeal Membrane Oxygenation
2. Esophageal Pressure Monitoring
Summary
Risk Management Pitfalls in Mechanical Ventilation in the Emergency Department
Case Conclusions
Clinical Pathway for Ventilator Management in the Emergency Department
Tables and Figures
1. Table 1. Predicted Body Weight for Females of Various Heights and Associated Tidal Volumes
2. Table 2. Predicted Body Weight for Males of Various Heights and Associated Tidal Volumes
3. Table 3. Examples of Initial Ventilator Settings for Obstructive Physiology (Asthma/COPD), Volume Assist-Control Mode
4. Table 4. Examples of Initial Ventilator Settings for ARDS Patients, Volume Assist-Control Mode
5. Table 5. ARDSNet Trial FiO2/PEEP (cm H2O) Protocol, Lower Versus Higher Strategy
6. Table 6. Example of Initial Ventilator Settings for Patients With a Severe Metabolic Acidosis, Volume Assist-Control Mode
7. Table 7. Scenarios and Their Associated Peak Pressure and Plateau Pressure Changes
8. Figure 1. Normal Output of Waveform Capnography
9. Figure 2. Waveform Capnography Demonstrating Bronchospasm
10. Figure 3. Peak Versus Plateau Pressure
11. Figure 4. Graph of Flow Versus Time
12. Figure 5. An Expiratory Hold Demonstrating Auto-PEEP (Pressure Above the Set PEEP)
References

Module 2: Mechanical Ventilation of Pediatric Patients in the Emergency Department

Abstract
Case Presentations
Introduction
Critical Appraisal of the Literature
Etiology and Pathophysiology
Prehospital Care
Diagnostic Studies
Management
1. Mode of Ventilation
  1. Synchronized Intermittent Mandatory Ventilation
  2. Assist-Control Ventilation
  3. Spontaneous Supported Ventilation
  4. Choosing the Mode of Ventilation
2. Pressure Control Versus Volume Control
3. Ventilation Goals
4. Oxygenation Goals
5. Respiratory Rate
6. Analgesia, Sedation, and Neuromuscular Blockade
7. Specific Patient Populations and Pathology
  1. Patients With Obstructive Lung Disease
  2. Patients With Significant Metabolic Acidosis
  3. Patients With Noncardiogenic Pulmonary Edema and Pediatric Acute Respiratory Distress Syndrome
  4. Patients With Refractory Hypoxemia
  5. Evaluation of Complications
Special Circumstances
1. Mechanical Ventilation of Patients With Highly Communicable Diseases
Controversies and Cutting Edge
1. Extracorporeal Membrane Oxygenation
Disposition
Summary
Risk Management Pitfalls in Mechanical Ventilation of Pediatric Patients in the Emergency Department
Case Conclusions
Tables and Figures
1. Table 1. Etiologies of Respiratory Failure
2. Table 2. Indications for Mechanical Ventilation
3. Table 3. Ventilator Terminology
4. Table 4. Suggested Initial Ventilator Settings for Pressure Control
5. Table 5. Suggested Initial Ventilator Settings for Volume Control
6. Table 6. Titration of Oxygenation and Ventilation
7. Table 7. State Behavioral Score
8. Table 8. Suggested Weight-Based Medication Dosing
9. Table 9. DOPES Mnemonic
10. Figure 1. Schematic Representation of Flow During Controlled Mechanical Ventilation
References

Module 3: Supraglottic Airway Devices for Pediatric Airway Management in the Emergency Department

Abstract
Case Presentations
Introduction
Critical Appraisal of the Literature
The History of Supraglottic Airway Devices
Benefits of Supraglottic Airway Devices
Common Supraglottic Airway Devices
1. LMA® Classic™
2. Intubating LMA/LMA® Fastrach™
3. LMA® ProSeal™ and LMA® Supreme™
4. Combitube®
5. Laryngeal Tube Airway
6. i-gel®
7. Baska Mask®
Video: Insertion of Supraglottic Airway Devices
The Difficult Airway
1. Anatomically Difficult Airways
  1. Congenital Abnormalities
  2. Acquired Conditions
2. Managing the Difficult Airway
Prehospital Care
Emergency Department Evaluation
1. History
2. Physical Examination
  1. Mouth Characteristics
    - Dentition and Palate
    - Inter-incisor Gap
    - Modified Mallampati Score
    - Upper-Lip Bite Test
    - Micrognathia
  2. Thyromental and Hyomental Distances
  3. Cervical Spine
Diagnostic Studies
Special Circumstances and Challenges
Controversies
Disposition
Summary
Risk Management Pitfalls When Using Supraglottic Airway Devices in Pediatric Patients
Time- and Cost-Effective Strategies
Case Conclusions
Tables and Figures
1. Table 1. Recommended Sizing for the LMA® Classic™ and LMA® ProSeal™, Based on Patient Weight
2. Table 2. Recommended Sizing for the King LTS-D™, Based on Patient Weight and/or Height
3. Table 3. Recommended Sizing for the i-gel®, Based on Patient Weight
4. Table 4. Recommended Sizing for the Baska Mask®, Based on Patient Weight
5. Table 5. Anatomic Features Associated With Difficult Airways in Children
6. Figure 1. The LMA® Classic™
7. Figure 2. The Standard Technique of Placing the LMA® Classic™
8. Figure 3. LMA® Fastrach™
9. Figure 4. LMA® ProSeal™
10. Figure 5. LMA® Supreme™
11. Figure 6. Combitube®
12. Figure 7. King LTS-D™
13. Figure 8. i-gel®
14. Figure 9. Baska Mask®
15. Figure 10. Modified Mallampati Score
16. Figure 11. Upper-Lip Bite Test
17. Figure 12. Positive Palm Print Sign and Prayer Sign
References