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Proc (Bayl Univ Med Cent). 2008 April; 21(2): 192. PMCID: PMC2277357
Copyright © 2008, Baylor University Medical Center
SLAM:
Street Level Airway Management, by James Michael Rich and 24 contributors
Reviewed by Michael A.E. Ramsay, MD
The
reviewer, Michael A. E. Ramsay, MD, is chief of the Department of Anesthesiology and Pain Management at Baylor University
Medical Center and president of the Baylor Research Institute.
Upper Saddle River, NJ: Pearson Education Inc, 2008. Paperback,
400 pp., $40.00.
Top This first-edition
book on emergency and difficult airway management arose from a series of courses presented by the author. Jim Rich used his
training as a certified nurse anesthetist and his extensive experience in airway management to coordinate this text. He worked
with 24 collaborators: 23 with extensive airway management experience plus an expert in scientific communication. Two of the
coauthors hold patents on airway device inventions used extensively in securing difficult airways: Michael Frass, professor
of medicine at the Medical University of Vienna, designed the Combitube, an esophageal-tracheal double-lumen airway for combined
endotracheal and esophageal obturator ventilation, and George Beck designed an airflow indicator, or “whistle,”
for facilitating blind intubations. Another contributor, Andrew Mason, is an anesthesiologist who travels with paramedics
in a helicopter to motor vehicle collision sites; he has extensive experience in gaining control of trauma victims' airways.
I also coauthored parts of two chapters and strongly encouraged Jim Rich to complete this endeavor. Among the other contributors
are several international peers as well as many national experts. The outcome of this work is a first-class text on airway
management.
What sets this text apart from many other texts on airway management is the hands-on practicality that pervades
the book. It emphasizes the concept that if your patient can't breathe, nothing else matters. Patients die or get severely
injured from failure to ventilate and oxygenate, not failure to intubate. The SLAM concept explains alternative techniques
for managing the patient with the difficult airway, including use of the latest technology. The title of this book might suggest that it helps a man or woman on the street deal with an emergency airway situation.
In fact, the target audience is a broad group of practitioners, from paramedics to medical residents, respiratory therapists,
intensivists, emergency medicine physicians, nurse anesthetists, anesthesiologists, and trauma surgeons. The 19 chapters cover airway anatomy, airway assessment and evaluation, numerous
airway management techniques, airway devices, monitoring techniques, pharmacology, and legal implications. The first chapter
describes the SLAM Universal Adult Airway Flowchart. This algorithm was designed to be used by all airway practitioners, regardless
of location. It received the prize for best scientific exhibit for clinical application at the 57th Postgraduate Assembly
of the New York State Society of Anesthesiologists in December 2003. Although the book focuses on adults, one chapter is devoted
to pediatric airway management. This chapter reviews the anatomical differences in children, gives the readers guides to recognize
the difficult airway, and includes some basic pharmacology of commonly used pediatric airway drugs. Other chapters address
burns to the airway, inhalational injuries, and sedation and analgesia protocols for postintubation management. Nosocomial
infection management is also addressed. Many of the chapters use the case study format to bring home the value of a particular
algorithm. Although the content is very detailed, a number of
formatting features aid readability and application. The text is enhanced by excellent figures, photographs, and drawings
that simplify and reinforce the concepts. “Pearls” and “On Target” sidebars are used throughout to
highlight main points, and review questions are provided at the end of each chapter. The references appear at the back of
the book under chapter headings, allowing the text to flow better. The text is full of acronyms—perhaps to be expected,
as the title itself is an acronym!—and that can be distracting. Fortunately, a glossary at the end of the book explains
not only medical terms but also the acronyms. Baylor can be
proud that “one of its own” produced this comprehensive and readable text that will be helpful to so many practitioners
and may be instrumental in saving lives. It is also a bargain, priced at $40, which is much less expensive than similar texts.
This could perhaps be called a “SLAM”-dunk book for anyone who might be involved in airway management!
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Author's Overview of SLAM: Street Level Airway
Management
Breathing is the Key - Education is the Answer! This book offers current information on emergency and difficult airway management from the "Street
Level" through all areas of the hospital!
My goal in writing SLAM: Street Level Airway Management was to
create a cutting edge, evidence-based book on emergency and difficult airway management. I wanted to produce a book that offers
solutions to emergency and difficult airway situations for those practicing from the "street level" through all
areas of the hospital, which is what the SLAM Airway Course has done for nearly a decade. I have practiced nurse anesthesia
for nearly 30 years, which has allowed me to teach emergency and difficult airway management to many different types of providers.
This has resulted in me collaborating with a seasoned group of 24 international airway experts, educators, researchers, inventors
and practitioners from all areas of clinical practice to write this practical text. My hope is that this book will become
an indispensable benefit to any practitioner who needs to provide safe and effective airway management, regardless of the
professional discipline in which he of she is practicing. At about a penny a page it is a real bargain.
SLAM:
Street Level Airway Management is based upon my emergency and difficult airway flowchart and my SLAM Emergency Airway Provider
Course. Using the SLAM Concept and the SLAM Universal Adult Airway Flowchart as a starting point, it focuses on the fundamental
aspects of anatomy, patient condition and clinical considerations promoting both patient safety and clinical competency. The
book brings together information that has been taught for years at the SLAM courses and presented at the slamairway.com website.
Excellent figures (photos, detailed drawings and line drawings) as well as clearly presented tables simplify and reinforce
the learning of difficult topics.
SLAM: Street Level Airway Management offers a practical approach for prehospital
practitioners (paramedics & flight nurses) as well as hospital based providers such as respiratory care practitioners,
CRNAs, residents and physicians practicing airway management. It instructs practitioners on a number of levels on how to:
a) form a plan of care; b) assess and evaluate the airway; c) effectively oxygenate and ventilate critically ill patients;
d) increase success in passing the tracheal tube on the first attempt; e) rescue failed intubation and effectively perform
rescue ventilation; f) utilize AHA approved methods to confirm tracheal intubation and monitor lung ventilation; g) deal with
special airway situations seen during trauma, burn and inhalation injuries, c-spine injury, pregnancy and pediatrics; and
h) effectively apply advanced intubation techniques. Chapters include: 1) SLAM Universal Adult Airway Flowchart; 2) Airway
Anatomy and Assessment; 3) Oxygenation and Ventilation in Adults; 4) Direct Laryngoscopy and Tracheal Intubation; 5) Confirmation
of Tracheal Intubation and Monitoring of Lung Ventilation; 6) Pharmacology of Airway Management; 7) Rapid Sequence Induction
and Intubation in Adults; 8) Rescue ventilation; 9) Advanced Techniques for Difficult Intubation; 10) Fiberscopic and Video-Assisted
Intubation; 11) Lightwand Intubation; 12) Cricothyrotomy; 13) The Traumatized Airway; 14) The Cervical-Spine-Injured Patient;
15) Burns and Inhalation Injuries; 16) The Pediatric Airway; 17) Sedation/Analgesia for Postintubation Management; 18) Legal
Implications of Emergency Airway Management; and 19) Nosocomial Risks of Airway Management.
Besides showing effective
ways to deal with difficult ventilation and rescue failed intubation, the book also introduces and reinforces some cutting-edge
topics, such as: 1) Mason's PU-92 concept; 2) Recognition & Management of Critical Airway Events; 3) 6-D Method of Difficult
Airway Assessment; 4) Bougie-Assisted Intubation; 5) Use of CPAP, BiPAP and proper use of supraglottic airway devices; 6)
Rescue Ventilation; 7) Simple Rescue Intubation techniques; 8) AHA and ILCOR Guidelines 2005 recommendations; and 9) The SLAM
Universal Adult Airway Flowchart: the flowchart's 5 pathways can be easily followed using the full-color 11" X 17"
high resolution copy of the flowchart that is included as a foldout of the inside front cover. Everyone from EMTs and paramedics
through healthcare educators in prehospital care, pulmonary medicine, intensive care, respiratory care, anesthesiology and
emergency medicine should find this book valuable for learning, teaching and practicing emergency and difficult airway management,
from the prehospital "street level" through all areas of the hospital.
SLAM: Street Level Airway Management's
contribution to the field of airway management is based upon its overarching message: "Patient's Die or Suffer Debilitating
Brain Injury from Failure to Ventilate and Failure to Oxygenate - Not From Failure to Intubate". Therefore, Learn SLAM:
Street Level Airway Management, Because If Your Patient Can't Breathe - Nothing Else Matters!!!
SLAM - Street Level Airway Management
by James Michael Rich, CRNA Pearson Prentice Hall – Upper Saddle River, New Jersey 07458 Book Chapters, Reviewers and
Contributors. Chapters Introduction: The SLAM Concept Chapter 1 SLAM Universal
Emergency Airway Flowchart 1 Chapter 2 Airway Anatomy and Assessment
19 Chapter 3 Oxygenation and Ventilation in Adults 37 Chapter 4 Direct Laryngoscopy and Tracheal Intubation 77 Chapter 5 Confirmation of Tracheal Intubation and Monitoring of Lung Ventilation 111 Chapter 6 Pharmacology
of Airway Management 127 Chapter 7 Rapid Sequence Induction and Intubation
in Adults 137 Chapter 8 Rescue Ventilation 147 Chapter 9 Advanced Techniques for Difficult Intubation 173 Chapter 10 Fiberscopic and Video-Assisted Intubation 189 Chapter 11 Lightwand Intubation 205 Chapter 12 Cricothyrotomy
213 Chapter 13 The Traumatized Airway 237 Chapter 14 The Cervical-Spine-Injured Patient 247 Chapter 15 Burns and Inhalation Injuries 259 Chapter
16 The Pediatric Airway 267 Chapter 17 Sedation/Analgesia
for Postintubation Management 287 Chapter 18 Legal Implications
of Emergency Airway Management 293 Chapter 19 Nosocomial
Risks of Airway Management 307 Answers to Review Questions 313 References 321 Glossary 362
Reviewers xiii Bryan E. Bledsoe, DO, FA,
CEP, EMT-P
Emergency Physician
Midlothian,
Texas
and
Adjunct Associate Professor of Emergency Medicine
The George Washington University Medical Center
Washington, DC Timothy P. Duncan, RN, CCRN, CEN, CFRN, EMTP
Flight Nurse/St. Vincent Mercy Medical Center Life Flight
Toledo, OH Randal Gray,
MA Ed, NREMT-P
Director, Office of
EMS
University of Alabama at Birmingham Russell Griffin, NR/CC-P
EMS Captain
McKinney Fire/EMS
McKinney, Texas Sean Kivlehan, EMT-P
EMS Coordinator/Instructor
Mount Pleasant Fire Dept.
Racine,
WI Joseph J. Mistovich, M.Ed, NREMT-P
Chair and Professor
Department of health Professions
Youngstown State University
Youngstown, Ohio Brian Petrone PA-C, EMT-P
Burlington, Massachusetts
Susie Vigh, BSRRT, NREMT-P, EMSI
EMT Program instructor
Polaris Career Center
Middleburg Hts, OH Matthew Zavarella, RN, NREMT-P, MS, SRNA,
CFRN, CCRN, CEN
Flight Nurse State
MedEvac
Pittsburgh, PA
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