BACK OPEN THE WALK IN THE APP ▸
EMERGENCY DEPARTMENT · WALL POSTER

SALAD — Suction-Assisted Laryngoscopy

DECIDEDecontaminate, THEN intubate. · Massive emesis, upper GI bleed (Massive Hematemesis), hemoptysis, drowning, cardiac arrest. · Lead with suction.
STEPS  ·  ◆ KEY STEP — LOGGED WITH ITS TIME
THE THREE TRAJECTORIES — WHICH WAY IS IT COMING FROM?
  1. The direction of flow decides the technique.
  2. 1 — UP from the GI tract. Park the catheter in the hypopharynx as a continuous drain.
  3. 2 — UP from the lungs. Aim the bougie at the froth and feel for tracheal rings or a firm stop when you pass into the bronchus.
  4. 3 — DOWN from above. Suction to navigate. Do NOT park deep.
SETUP — BEFORE YOU GIVE THE DRUGS
  1. IN THE KIT — SALAD SUCTION KIT Two suction units, both tested, both with a canister that has capacity.
  2. DuCanto rigid catheter x2 — DuCanto (about 0.26 inch / 6.6 mm bore, no thumb port, curve matched to hyperangulated blades) and/or HI-D Big Stick (thumb port, milder curve, suits direct laryngoscopy).
  3. Meconium aspirator and a spare 8.0 ETT.
  4. Bougie · airway-exchange catheter · NG/OG tube · ETCO₂ · cricothyrotomy kit open.
  5. The Yankauer is the backup, not the primary catheter.
  6. POSITION AND PRIME Head up at least 20°, or steep reverse Trendelenburg.
  7. Park one suction under the right shoulder or at the corner of the bed.
  8. Decompress the stomach before induction. Bag-mask pressures under 20 cmH₂O.
THE SEQUENCE
  1. 1. Suction in the right hand, overhand grip. Laryngoscope in the left. Lead with the suction.
  2. 2. Sweep from the right corner of the mouth to the midline, decontaminating along the tongue as you go.
  3. 3. Blade in along the tongue.
  4. 4. Suction the hypopharynx, then advance into the proximal esophagus as a drain.
  5. 5. The SALAD park: catheter to the LEFT corner, pinned by the blade, tip at the esophageal inlet.
  6. 6. Deliver the tube with the second suction ready in someone else’s hand. ◆ TUBE DELIVERED — SALAD
  7. 7. Cuff up, suction down the ETT, THEN ventilate and confirm ETCO₂.
  8. 8. Place an OG tube. ET tube blocked? Meconium aspirator on it and suck it through.
FIGURE
2 SUCTIONS · TESTED · LARGE-BORE RIGID
HEAD UP ≥20° · BMV <20 CMH₂O
TRAJECTORY 1 GUT → PARK IN ESOPHAGUS
TRAJECTORY 2 LUNG → BOUGIE TO THE FROTH, CUFF + PEEP
TRAJECTORY 3 ABOVE → NAVIGATE ONLY, DO NOT PARK DEEP
SUCTION THE TUBE BEFORE THE FIRST BREATH
PITFALLS

One suction unit. An untested suction unit. A Yankauer as the primary catheter.

Laryngoscoping before decontaminating — or suctioning endlessly without the blade in.

Trying to pass a bougie through a standard suction catheter.

Working the suction and the laryngoscope alone when there is a second pair of hands in the room.

Parking deep when the blood is coming down from the face.

Never let this delay a cricothyrotomy in a patient you cannot oxygenate.