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Life in the Fast Lane • LITFL • Medical Blog

Emergency medicine and critical care medical education blog

Critical Care Compendium | Suction Assisted Laryngoscopy Airway Decontamination (SALAD)

Suction Assisted Laryngoscopy Airway Decontamination (SALAD)

by Chris Nickson, Last updated August 21, 2018

Reviewed and revised 5 April 2015

OVERVIEW

  • Suction Assisted Laryngoscopy Airway Decontamination (SALAD) is the term coined by Jim Du Canto and colleagues for a suction technique used to preventing airway soiling during laryngoscopy when there is profuse regurgitation

TECHNIQUE

The technique, as described by Jim Du Canto, involves the following steps:
  1. Oral decontamination followed by laryngoscope blade insertion hugging the surface of the tongue (anteriorly) so as to avoid submerging the illumination/optics module in vomitus (thank you to Seth Manoach M.D. for this vital detail).
  2. Use of the rigid suction catheter as a tongue depressor/lifter to permit the laryngoscope blade perfect position on the first attempt
  3. Further decontamination of the hypopharynx, followed by insertion of the rigid suction catheter into the proximal esophagus to serve as a continued drain of emesis
  4. Repositioning of the suction catheter to the left corner of the patient’s mouth facilitated by a slight withdrawal and reinsertion of the laryngoscope blade to permit this transit.  The laryngoscope blade will now effectively pin the suction catheter in place with this maneuver, as the left portion of the blade contacts the right portion of the suction catheter, securing it in place and holding it out of the path of endotracheal intubation
  5. Slight rotation of the laryngoscope blade leftward 30 degrees to further open a channel for endotracheal tube passage through the pharynx and into the larynx.  Inflation of the endotracheal tube cuff and suctioning of the tracheal tube and trachea prior to ventilation to avoid spreading any aspirated material

References and Links

FOAM and web resources

  • Jellybean 051. Jim DuCanto interview
  • Video of the SALAD technique by James Du Canto (2015)

 

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About Chris Nickson

FCICM FACEM BSc(Hons) BHB MBChB MClinEpid(ClinTox) DipPaeds DTM&H GCertClinSim

Chris is an Intensivist at the Alfred ICU in Melbourne and is an Adjunct Clinical Associate Professor at Monash University. He is also the Innovation Lead for the Australian Centre for Health Innovation and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia's Northern Territory, Perth and Melbourne. He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. He coordinates the Alfred ICU's education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the 'Critically Ill Airway' course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of Lifeinthefastlane.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. His one great achievement is being the father of two amazing children. On Twitter, he is @precordialthump.

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