S.A.L.T. Airway TIPS by balawrence

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S.A.L.T. Airway Training Materials

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									                      S.A.L.T. Airway
Surpraglottic Airway Laryngopharyngeal Tube
    Product Support
    S.A.L.T. TIPS

    This presentation is designed to answer
    common questions and provide tips and
        tricks for successful S.A.L.T use

        Contact your ECOLAB Region Manager for additional resources

Alternate Care Markets Team
                  Always feel free to call our team
   Annette Donaldson                                        Tony Maru
   Region Manager – West                            Region Manager – East
     Alternate Care Markets                             Alternate Care Markets
           Healthcare                                         Healthcare
 annette.donaldson@ecolab.com                           tony.maru@ecolab.com
          847.902.6009                                       203.215.1541

                            Brooke A. Lawrence
                                Sales Manager
                              Alternate Care Markets
Why does the SALT work?

 The S.AL.T. works by simply blocking the esophagus and aligning the
 distal, or end of the S.A.L.T. to be just beneath the opening to the trachea.
 The “ramp” area of the SALT guides the Endotracheal tube into the
 trachea. (see SALT placement slide). The S.A.L.T stays in place after
 intubation to act as a bite block for patients who would involuntarily chew
 on the Endotracheal tube.
What comes in the Package?
 Part Number: 79-500

 S.A.L.T.   Airway
 Endotracheal    Tube Holder/Clamp
 Securing   Strap
 Epiglottis/Tongue    Blade
 Instructions   for Use

 Supraglottic Airway Laryngopharyngeal Tube

 What   does the S.A.L.T. do?
     Oral Airway – OPA
     Blind Intubator
     Bite Block
     Tube Securing Device
Think of S.A.L.T. As……

An   INTUBATING Oralpharyngeal Airway –OPA
S.A.L.T   is the FIRST such device
Easy   to Use
Every   EMT has been trained to use an OPA
A   new device that will change the standard of care

When can the S.A.L.T. Airway be used?

 Apneic      patients without an intact gag reflex
        Respiratory Arrest
        Cardio-Respiratory Arrest
        No Need to Stop CPR to Endotracheal Intubate a patient

How can the S.A.L.T. be used

 Standard     Oralpharyngeal Airway – OPA
      Capable of moving High Volumes of air, due to the large lumen
      Inserted by Basic and Advanced EMTS / Paramedics

 Intubation    Device
      Fast, Safe, and Effective
      No Need to Stop CPR to Endotracheal Intubate a patient

 Airway Review

Distal end of SALT Airway
Air Path into the Trachea/Lungs
SALT Placement
                 Placement of distal end of SALT
How to insert the S.A.L.T.
 Open     Airway
 Pre   Oxygenate / Ventilate
 Measure  from the corner of the mouth to the
  opposite angle of the jaw
 Lubricate    distal end of SALT, water soluble
 Grasp  SALT like a pencil, between thumb and
 Align   Airway to a neutral position
 Inserttongue blade deep into patient’s posterior
  oropharynx and push anteriorly, retracting the
    1) displacing the tongue and 2) displacing the epiglottis
    Allowing the SALT to seat properly against the

     corniculate cartilage
How to insert the S.A.L.T.
 Insert SALT until to full depth or you meet resistance
    Using provided tongue blade to maintain control of

     the epiglottis

    Remove Tongue Blade from pt’s mouth

 Ventilate   Patient with BVM or pocket-style mask
 S.A.L.T.    can be placed in a patient for 6 hours

 Ifrescuer encounters poor ventilatory
  compliance; remove SALT, hyperoxygenate
  patient, and re-attempt SALT insertion.
How to Endotracheal Intubate via S.A.L.T.
 Ventilate   patient with Bag Valve Mask
 Apply    Gentle cricoid pressure – Sellick’s Maneuver
 InsertLUBRICATED Endotracheal Tube (ETT) and advance to proper
  depth 23-24 cm at proximal end of S.A.L.T.

     MOVEMENT. The ET tube should move down the patients midline.
 Ventilate   patient with Bag Valve Mask / Verify ET tube placement
     Observe adequate chest rise
     auscultating over epigastric region for absence of gurgling sounds

     auscultating over lung fields (left and right anterior chest/left and right lateral chest) for

      presence of bilateral breath sounds
     observing condensation in endotracheal tube

     utilizing an end-tidal CO2 detector and observing color change indicative of adequate

      concentration of CO2
     utilizing an esophageal intubation detector

     utilizing capnometry/capnography and observing readings/waveforms indicative of

      adequate concentration of CO2
How to Endotracheal Intubate via S.A.L.T.
                                                                                    Pg 2
 Inflate   distal cuff of ET Tube
 Re-verify   tube placement
      Following local Protocol

 Secure     ET Tube with S.A.L.T. Tube clamp, using clamp and strap
      Place endotracheal tube securing clamp around endotracheal tube at the superior edge
       of the SALT. Note tube depth.
      Secure clamp firmly around endotracheal tube. Do not crush or collapse et tube.

      Attach securing strap to posts on endotracheal tube securing clamp; Adjust strap to

       proper tension.
      Re-verify endotracheal tube placement after securing tube.

Helpful Tips / Trouble Shooting
 Look      for the possibility of the SALT getting caught on the epiglottis
      You will notice the SALT will stop advancing at approximately 50% of its length
      Use the provided tongue/epiglottic blade to control the epiglottis, lifting it to allow the

       SALT to pass into place.
 Keep  the S.A.L.T. midline to ensure an inline path to the trachea, a few
  centimeters will make a difference
        Look for skin tenting on the lateral (side) aspect of the neck. This will indicate the
         S.A.L.T. is not midline. Reposition by rotating the S.A.L.T. in the opposite
         direction, to realign.
 Ifthe S.A.L.T. is to short for the patient, it could result in an Esophageal
      Verify correct size S.A.L.T. for your patient.
      You can use an oversized device in an undersized patient. However you may have to

       remove the S.A.L.T. after successful intubation.
      We are working on additional sizes

Helpful Tips / Trouble Shooting
 Always  remember to lubricate the distal end of the S.A.L.T. and the distal
  end of the ET Tube.
 Ifresistance is encountered upon attempted insertion of endotracheal tube,
  this indicates that the endotracheal tube has most likely entered the
  valluculae or right pyriform sinus.
        This is a result of the distal end of the SALT “catching” the epiglottis and folding it
         backward. This occurs when the epiglottis is not properly displaced, possibly from
         shallow advancement of the tongue blade. Remove endotracheal tube, remove SALT,
         and hyperoxygenate patient prior to reattempts at SALT insertion or other airway
         management procedures.
 Ifesophageal placement is either detected or suspected, the endotracheal
  tube should be immediately removed and the patient should be ventilated
  via bag-valve mask and supplemental oxygen prior to reattempted
  endotracheal intubation or alternative airway management.

Helpful Tips / Trouble Shooting

 Because the SALT serves to protect against accidental endotracheal tube
 extubation, it is recommended that the SALT not be removed during the
 pre-hospital phase of care unless absolutely necessary. The SALT should
 be removed within 6 hours of application.
 The  SALT endotracheal tube securing clamp and strap are designed to be
 utilized in conjunction with the SALT airway as an airway management
 system. The SALT endotracheal tube securing clamp and strap should not
 be utilized by itself due to the possibility of pressure ulcerations.

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