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Advanced Life Support

AIRWAY

MANAGEMENTAND VENTILATION

2/15/2003 , 1

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Airway management & ventilation

Objective

Basic airway management

and ventilation The laryngeal mask airway

and Combitube

Advanced techniques of

airway management

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Common causes of airway obstruction

Upper Airway

tongue

soft tissue oedema, foreign material

blood, vomit

Larynx

laryngospasm, foreign material

Lower Airway

secretions, oedema, blood

bronchospasm

as iration of astric contents3

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Recognition of airway obstruction

LOOK for chest/abdominal

movement

LISTEN at mouth and nose for breath

sounds, snoring, gurgling

FEEL at mouth and nose for

expired air

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Opening the airway

Head tilt

Chin lift

Jaw thrust

CAUTION! cervical spine

injury

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Head Tilt and Chin Lift

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Advanced Life SupportJaw Thrust

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Advanced Life SupportSuction

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Simple airway adjuncts

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Oropharyngeal Airway

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Nasopharyngeal Airway

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Mouth to mask ventilation

Advantages:

Avoids direct person toperson contact

Decreases potential forcross infection

Allows oxygenenrichment

Limitations:

Maintenance of airtightseal

Gastric inflation12

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Bag-valve-mask, 2-person ventilation

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Ventilation using self inflating bag

Advantages

Avoids direct person to person contact

Allows oxygen supplementation up

to 85%

Can be used with facemask, LMA,Combitube, tracheal tube

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Ventilation using self inflating bag

Limitations

When used with a facemask:

Risk of inadequate ventilation

Risk of gastric inflation

Need two persons for optimal use

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Advanced Airway

Management

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The Laryngeal Mask Airway

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The Laryngeal Mask Airway

Advantages

Rapidly and easily inserted

Variety of sizes More efficient ventilation than

facemask

Avoids the need for laryngoscopy

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The Laryngeal Mask Airway

Limitations

No absolute guarantee against

aspiration Not suitable if very high inflation

pressures needed

Unable to aspirate airway

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Advanced Life SupportThe Laryngeal Mask Airway

Fig 1

Fig 2 Fig 3

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The Laryngeal Mask Airway

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The Combitube

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The Combitube

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The Combitube

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Advantages

Rapidly and easily inserted

Avoids need for laryngoscopy

Protects against aspiration

Can be used if inflation pressureshigh

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Limitations

Available in 2 sizes only

Potential for ventilation via wronglumen

Damage to cuffs on insertion

Trauma on insertion

Single use

The Combitube

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The Combitube

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Tracheal Intubation

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Tracheal Intubation

Advantages

Allows ventilation with up to 100% O2

Isolates airway, preventing aspiration

Allows aspiration of the airway

Alternative route for drugadministration

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Limitations

Training and experience essential

Failed insertion, oesophageal

placement

Potential to worsen cervical cord orhead injury

Tracheal Intubation

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Needle CricothyroidotomyIndication

Failure to provide an airwayby any other means

Complications

Malposition of cannula

Emphysema

Haemorrhage

Oesophageal perforation

Hypoventilation

Barotrauma

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Any Questions?

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Summary

Recognise and relieve airway

obstruction using basic

techniques

Oxygen

The role of the LMA, Combitubeand tracheal intubation in

managing the airway during CPR32