EMS Mnemonics - SALAD

For EMS providers, understanding the SALAD mnemonic in the context of airway management is crucial for effectively dealing with contaminated airways, particularly in emergency situations.

The SALAD (Suction-Assisted Laryngoscopy and Airway Decontamination) technique was developed by Dr. James DuCanto. Dr. DuCanto is an anesthesiologist and the Director of the Simulation Center at Aurora St. Luke's Medical Center in Milwaukee, Wisconsin. He is known for his contributions to airway management and the development of innovative techniques, including SALAD.

The SALAD technique is designed to address challenges in managing the airways of patients who are actively vomiting or have a risk of airway contamination. It involves the proactive use of suction to clear the upper airway before and during laryngoscopy, with the goal of optimizing visualization and reducing the risk of aspiration during emergency airway management. The technique often involves the use of the Ducanto catheter, a rigid suction catheter specifically designed for emergency airway situations.

Here's what EMS providers need to know about SALAD:

SALAD Mnemonic:

S - Suction-Assisted: The SALAD technique involves suction-assisted airway management. It emphasizes the proactive use of suction to clear the upper airway of contaminants such as blood, vomit, or other secretions.

A - Laryngoscopy & Airway Decontamination: SALAD stands for Suction-Assisted Laryngoscopy and Airway Decontamination. The primary goal is to optimize visualization during laryngoscopy while simultaneously decontaminating the airway.

L - Laryngoscope Blade-Like Use of Suction Catheter: The rigid suction catheter is used in a manner similar to a laryngoscope blade. It is employed to compress the tongue, distract the lower mandible, and lift the base of the tongue off the posterior pharyngeal wall. This technique aids in the insertion of oral airways, supraglottic airways (SGAs), and laryngoscopes.

A - Aspiration Prevention: One of the main objectives of SALAD is to prevent massive aspiration during emergency airway management. Proactive suctioning is employed before basic and advanced life support maneuvers to reduce the potential for forcing aspiration of airway contaminants.

D - Ducanto Catheter Utilization: The SALAD technique often involves the use of the Ducanto catheter, a rigid suction catheter designed for emergency airway management. The catheter assists in clearing the upper airway and plays a role in creating space during the insertion of oral airways, SGAs, and laryngoscopes.

Key Points for EMS Providers:

Clinical Context: SALAD is particularly relevant in situations involving copious secretions, blood, or emesis, such as out-of-hospital cardiac arrest (OHCA) scenarios.

Operator Proficiency: EMS providers must be technically proficient in the SALAD technique to ensure effective airway management without compromising the view of the airway.

Proactive Suctioning: The proactive use of suction as the initial step in emergency airway management is emphasized. This helps prevent aspiration during face mask ventilation and ventilation through SGAs.

Wider Application: While initially focused on managing contaminated airways, the SALAD technique's proactive use of a rigid suction catheter suggests potential applications in various emergency airway management scenarios.

Training: EMS providers should receive proper training and education on the SALAD technique, including the correct utilization of the Ducanto catheter and the proactive use of suction during airway interventions.

Understanding and implementing the SALAD mnemonic can enhance the capabilities of EMS providers in managing challenging airway situations, ultimately contributing to better patient outcomes during emergencies.

Further Reading:

Root, C. Et Al.(2020) Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A Technique For Improved Emergency Airway Management. Resuscitation Plus. Science Direct.

https://www.sciencedirect.com/.../pii/S2666520420300059 Accessed January 10, 2024