Advance Airway Mx

8/2/2019 Advance Airway Mx

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Advance airway Mx


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1) Laryngeal mask airway (LMA)

2) Esophageal-tracheal combitube

May provide superior ventilation compare

bag mask ventilation in victim of cardiac

arrest Health care provider should complete initial

training &maintain their knowledge& skill


3/17

Bag-mask ventilation is difficult to performeffectively (esp. by lone rescuer)

But remains single most important skill in airway

mx It is difficult to learn tracheal intubation

&maintain high level of skill without frequentuse &refresher training

Tracheal intubation is much more dangerousintervention


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Laryngeal mask airway (LMA)


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Laryngeal mask airway (LMA)

Is a adjunctive airway device compose of a

tube with a cuffed-mask like projection at the

distal end


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Insertion technique

LMA introduce into the pharyx and is blindlyadvance until resistant is felt

Resistance indicates that the distal end of the tube

has reached the hypopharynx The inflate the cuff of the mask

This pushes the mask up against the trachealopening; providing an effective seal

Ventilation occurs through the opening in thecenter of the mask


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8/17

Indication

Are the same as those for the tracheal tube

and combitube;

Inability of rescuer to ventilate the unresponsive

patient with less invasive methods.

Inability of patient to protect his/her airway (eg

coma, absent reflexes, cardiac arrest)

Continuing cardiac arrest with continuing need forcardiac compressions


9/17

Evidence

Insertion: Successful insertion rate :64%-100%

Ventilation : Provide more secure and reliable means of ventilation than facemask

Ventilation achieved is equivalent with tracheal tube

Airway protection Regurgitation is less likely(than with the bag-mask) and aspiration is

uncommon

Patient access Advantage over tracheal tube when access to patient is limited /

positioning of patient (for tracheal intubation) is impossible Training

Simpler than tracheal intubation (because skilled laryngoscopy for thepurpose of cord visualization is not necessary)


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Esophageal-tracheal combitube


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Invasive double lumen airway device with 2

inflatable balloon cuffs. 1. lumen contain ventilating side holes at the

hyphopharyngeal level& is closed at the end

2.Open end

Inserted without visualization of vocal cord


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Insertion technique

Advance the tube blindly until the 2 marks

printed on the tube are located at the patients

teeth then inflate pharyngeal(proximal) and

esophageal(distal) balloons; isolating theoropharynx above the upper balloon and the

esophagus(or trachea) below the lower balloon.

Asses the location of the distal orifice and thenventilate patient through appropriate lumen.


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14/17

Following blind insertion, the tip of combitubemost frequently rests in esophagus, althoughtracheal intubation may occur;

If the tip of tube (and orifice) lie within the trachea,the tracheal tube (the shorter white or light lumen) isuse for ventilation directly into the trachea

If the tips of tube (and the orifice) lie withinesophagus, the esophageal obdurator end is used todeliver ventilation from the side opening of the tube.

The combitube has no stylet in the distal lumen &immediate suctioning of gastric content is possible


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Indication

Are the same as those for tracheal tube; Inability of rescuer to ventilate the unresponsive

patient with less invasive methods.

Inability of patient to protect his/her airway (eg coma,

absent reflexes, cardiac arrest) Continuing cardiac arrest with continuing need for

cardiac compressions

Advantage over the facemask;

Isolates the airway Reduces risk of aspiration

Provides more reliable ventilation


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Advantage over the tracheal tube;

Less difficult to learn and acquire skill in the

technique

Supports more effective and efficient skills

maintenance


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Complication

Esophageal trauma

Subcutaneous emphysema

Providers should receive adequate training

and practice using the devise regularly.

Advance Airway Mx

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