Airway management is one of the most important jobs for pre-hospital care providers, but it isn’t always as straightforward as placing an endotracheal tube (ET). For example, how do you place a tube while the patient is vomiting? One answer is the SALAD technique, as developed and defined by James DuCanto, MD, staff anesthesiologist and Director of the Simulation Center Aurora, St. Luke’s Medical Center.
SALAD Technique Defined
The Suction-Assisted Laryngoscope Airway Decontamination (SALAD) technique requires a rigid suction catheter, suction unit, and laryngoscope. In addition to establishing the airway, it’s important to avoid too much vomitus contact with the instruments, especially if one is using a video laryngoscope.
First, all vomit is cleared from the mouth with the suction catheter. Then, the laryngoscope is inserted with its blade closely hugging the base of the tongue. The suction catheter should be deeper in the esophagus than the laryngoscope, so the optics aren’t obscured with contaminant. The suction catheter can be used as a tongue depressor while the laryngoscope is set.
After the suctioning the larynx, the suction catheter should be removed and repositioned to the left side of the mouth. Then the laryngoscope blade will pin it in place. This provides continuous drain of any vomit and frees the user to perform endotracheal intubation. Once the tube is successfully placed, the suction can be removed. This process is reviewed in full in the following video, which uses a task trainer to demonstrate the technique:
How to Simulate SALAD
Recent manikins have features that allow educators to easily coordinate expulsion of vomit while students attempt to establish an airway. For example, Nasco’s adult and child SALAD trainers offer realistic anatomy and a pump to easily release contaminant.
Both Medical Moulage: How to Make Your Simulations Come Alive and Moulage for Manikins! have sections devoted to recipes for making simulated vomit.