This document describes an advanced airway course designed for dentists. It notes that sedation dentists need skills beyond ACLS to manage airway emergencies. The course teaches techniques like endotracheal intubation, video laryngoscopy, supraglottic devices, and cricothyrotomy using simulators. It provides 16 CE credits over 2 days on standard and advanced airway techniques, special situations, and hands-on practice to help dentists safely manage airway crises.

1. An advanced airway course designed exclusively for dentists

2. “A difficult airway is defined as the clinical
situation in which a conventionally trained
anesthesiologist experiences difficulty with face
mask ventilation of the upper airway, difficulty
with tracheal intubation, or both.”
– suggested definition from current ASA Practice Guidelines

3.  Is the office prepared to respond
quickly and knowledgeably in the
event of a patient experiencing airway
complications or a respiratory crisis?
 Sedation dentists treating patients on
CNS depressants need to have the
ability to address airway emergencies,
and standard ACLS training will not
be enough.
 “The Advanced and Difficult Airway
for Dentists” course will empower
dentists with the ability to anticipate,
recognize and manage a failed airway.

4. ACLS ADVANCED AIRWAY
 Situation: Heart stops first—  Situation: Breathing stops first—
 Addresses emergency situations where  Addresses emergency situations where
the patient’s heart stops the patient stops breathing
 Seeks to prevent a “sudden death”  Seeks to prevent respiratory failure
scenario caused by cardiac arrest leading to a Michael Jackson death
scenario
 Protocols include use of AED to
resuscitate  Protocols include reestablishing and
maintaining an airway
 Example: A patient goes down, requires  Example: A patient goes down unable to
AED shock, likely goes on to lead a normal breathe, if deprived of oxygen too long,
productive life. can have permanent brain damage.
Immediate action is critical.

5. Expert instruction
Receive training from top-notch airway
and emergency experts
Applicable safety training
Enhance skills and learn code airway
techniques
Hands-on practice
Practice with state-of-the-art airway
devices and patient simulators
Advanced learning
Acquire difficult airway management
algorithms to help with challenging cases
Intimidation-free education
Study complex topics in a simple down-
to-earth way

6. ADVANCED AIRWAY EXAMPLE:
HANDS-ON EXPERIENCE COMMERCIAL AVIATION
 Patient simulators  Captain Sully never had to face an
 Pig throats for surgical airway practice engine failure until the day he made an
emergency landing in the Hudson River
when a “double bird strike” disabled
both engines on Flight 1549.
 Experience with flight simulators made
this possible.
 Precaution is everything.

7. For the standard, advanced & difficult airway
o Laryngoscope & direct laryngoscopy o Retrograde intubation
o Endotracheal tube & tracheal intubation o Extraglottic devices
o Optically-enhanced laryngoscopy o Awake intubation
o Lighted-stylet intubation o Local & topical anesthesia techniques
o Digital intubation o Methods for obese patients
o Percutaneous and surgical o Pediatric airways
cricothyrotomy o Alternative techniques for airway
challenges

8. LARYNGOSCOPE DIRECT LARYNGOSCOPY
1. Insert laryngoscope into mouth on right
side
 Essentially 2. Flip to left, trapping and moving tongue
a viewing out of line of sight
instrument Laryngoscope
with Miller Blades
3. Depending on type of blade, insert either
 Employed to obtain either direct or anterior (Macintosh) or posterior (Miller)
indirect view of vocal folds & glottis to epiglottis
to facilitate tracheal intubation
4. Lift with upward and forward motion
(away from operator and toward roof of
mouth)
5. View of glottis is obtained, ready for
tracheal intubation
Direct Laryngoscopy

9. ENDOTRACHEAL TUBE TRACHEAL INTUBATION
 Essentially a respiratory conduit 1. Facilitated by laryngoscope to identify
glottis (alternative methods also
 A flexible plastic or rubber tube inserted available)
into trachea (windpipe) to maintain an
open airway for oxygenation and 2. After trachea has been intubated,
ventilation of lungs typically a balloon cuff is inflated just
above the far end of the tube for the
 Procedure is invasive and extremely following reasons:
uncomfortable, usually performed with  To secure it in place
local or topical anesthesia  To prevent leakage of respiratory gases
A. Endotracheal tube  To protect tracheobronchial tree from
B. Cuff inflation w/ pilot
balloon
stomach acid and other undesirable
C. Trachea material
D. Esophagus
3. Secure tube to face or neck and
connect to other respiratory device, ie.
bag valve mask
Tracheal intubation

10. OPTICALLY-ENHANCED LARYNGOSCOPY EMERGENCY CRICOTHYROTOMY
 AKA indirect laryngoscopy  Last resort rescue technique
 Allows operator to see and intubate without  Percutaneous (needle) cricothyrotomy
direct line of sight, ie. via monitor or viewing  Quickest and safest cric method
port  Large bore intravenous catheter is used to
puncture cricothyroid membrane
LIGHTED-STYLET INTUBATION
 Gases can then be administered through
 Uses illumination to facilitate placement of
catheter
endotracheal tube
 Temporary measure to be used only until
 Correct placement is confirmed by anterior
more definitive airway can be established
glow in neck
 Insufficient for CO2 ventilation
DIGITAL INTUBATION
 Intubation without visual aid
 Surgical cricothyrotomy
 Rarely performed since airway devices  Incision is made through skin and cricothyroid
membrane in order to establish airway
provide alternative
 Tube is guided into trachea while using index
finger as a leverage point
 Since this technique is truly blind, correct
tube placement must be rigorously
confirmed
Needle cricothyrotomy

11. RETROGRADE INTUBATION EXTRAGLOTTIC AIRWAY DEVICES
1. Cannula is inserted through cricothyroid  Alternative to endotracheal tube
membrane into trachea
2. Guide wire is passed through needle  Example: King Tube
upward through vocal cords into pharynx
or mouth
3. Wire is used to guide endotracheal tube
through vocal cords
4. Wire is withdrawn and endotracheal tube
is advanced into trachea
 For blind insertion, intended to end up
in esophagus
 During ventilation air passes through
tube into pharynx and must enter
trachea because low-pressure balloons
seal pharynx and esophagus
 Simplifies use:
▪ King has single lumen which prevents
function if accidentally ends up in trachea
▪ Single pilot tube inflates both balloons
Retrograde intubation

12. AWAKE INTUBATION METHODS FOR OBESE, ASA III PATIENTS
 Advantage: significantly safer because
PEDIATRIC AIRWAYS
spontaneous breathing and
 Significant differences in airway anatomy
pharyngeal/laryngeal muscle tone is
and respiratory physiology
maintained
 Smaller airways, therefore any swelling
 Drawback: potential patient anxiety due to
can cause critical obstruction
inability to feel oneself swallow or cough,
loss of gag reflex ALTERNATIVE TECHNIQUES for addressing
airway anatomy challenges including:
LOCAL & TOPICAL ANESTHESIA TECHNIQUES
 Limited neck/jaw movement
 Lidocaine administered topically via spray-
as-you-go technique  Deep swelling due to allergy
 Targeted catheter stream technique  Unusual airway anatomy
 Nerve blocks via strategic lidocaine  Excess fatty tissue of face or neck
injections
 3 major neural pathways supply sensation to
airway structures

13. 16 CE credits, 2-day program or  Dr can elect to attend Day 1, Day 2, or
8 CE credits, 1-day program both
 Day 1 completion is a mandatory
DAY ONE prerequisite for Day 2
 Morning: standard airway techniques  Convenient for renewals
 Afternoon: advanced airway techniques
 Hands-on
 Renew every 2 years
 Textbook situations  Advanced Airway in-office training
available
DAY TWO
 Team training unification
 Special situations and strategies
 Tailored to the office
 Lecture, Dr. Ward
 Simulations
On completion, attendees will receive
an Airway Course Completion Card from the American Heart Association.
Note: AHA advanced airway cards are not provided for team members.

14. PUT PATIENT SAFETY FIRST AND GAIN PEACE HIGHLIGHTS
OF MIND
 General airway evaluation
 Respond quickly and knowledgeably if the
patient experiences an airway-related crisis  Methods for ASA III patients such as obese
or diabetic
 Recognize signs of a crisis before it occurs
 Pediatric airway techniques
 Experience expert instruction and hands-
on practice with best-in-class equipment  Supraglottic devices
and training personnel
 Digital intubation and other variations
 Acquire a wide range of skills to employ in
emergency situations  Percutaneous and surgical cricothyrotomy
 Practice with some of the best patient  Video laryngoscopy
simulators on the market
 Aids for difficult direct largyngoscopy
 Fulfill 16 AGD PACE-approved CE hours via
2-day course  Supplemental oxygen and respiration