Airway Management

Slide 1

Owymardyan Y Manafe 1015018Juni Royntan T 1015070

ANATOMY OF THE RESPIRATORY SYSTEMRespiration

VENTILATION

WHAT HAPPENED DURING VENTILATION

DEAD SPACE

ADEQUACY OF THE AIRWAYPatencyProtective reflexesInspired oxygen concentrationRespiratory drivePROBLEM RECOGNITIONType of TraumaHead TraumaMaxillofacial TraumaNeck TraumaLaryngeal Trauma

Airway ObstructionAgitatedCyanosisNoisy breathingTrachea locationInadequacy of VentilationChest movementDecreased breath soundPulse oximeter

Airway management10Basic Techniques to Open AirwayHead tiltChin LiftJaw ThrustTriasmanouvers11Triple Airway Manuever

Airway devicesOropharyngeal Airway (OPA)Nasopharyngeal Airway (NPA)Laryngeal Mask Airway (LMA)Multilumen Esophageal AirwayLaryngeal Tube Airway (LTA)Gum Elastic Tube / ETTI13Oropharyngeal Airway

14TechniqueClear the mouth and pharynx

Place the airway so that it is turned backward as it enters the mouth

As airway approaches the posterior wall of the pharynx rotate 180 degrees

15Contraindications to Oropharyngeal Airways

Inability to tolerate (gagging, vomiting)Airway swelling (burns, toxic gases, infection)Bleeding into the upper airwayAbsence of pharyngeal or laryngeal reflexesImpaired mouth opening (e.g., with trismus or temporomandibular joint dysfunction)

Nasopharyngeal Airway

17TechniqueAirway is lubricated with anesthetic jelly

Resistance slight rotation of the tube

18Contraindications to Nasopharyngeal Airways

Narrow nasal airway in young childrenBlocked or narrow nasal passages in adultsAirway swelling (burns, toxic gases, infection)Bleeding into the upper airwayAbsence of pharyngeal or laryngeal reflexesFractures of the mid-face or base of skullClinical scenarios in which nasal hemorrhage would be disastrous

Laryngeal Mask Airway (LMA)Airway adjunct with a cuffed mask-like projection at the distal end that is introduced to the pharynx

20LMA Introduced Through Mouth Into Pharynx

22Tracheal IntubationKeeps Airway patent

Ensures delivery of high concentration of oxygen

Ensures delivery of a selected tidal volume

Isolates and protects the airway from aspiration of stomach contents

Permits effective suctioning

Provides route for administration of several medications (Adrenaline, Sulfas atropine)23IndicationsCardiac arrest with ongoing chest compressions

Inability of conscious patient in respiratory compromise to breathe adequately

Inability of the patient to protect airway

Inability of the rescuer to ventilate the unresponsive patient with conventional methods24ComplicationsTraumateeth, lips, tongue, mucosa, vocal cords, tracheaEsophageal intubationVomiting and aspirationHypertension and arrhythmias25Equipment for IntubationLaryngoscope with several bladesTracheal tubesMalleable stylet10-mL syringeMagill forcepsWater-soluble lubricantSuction unit, catheters, and tubing

26Curved vs Straight Blade

Macintosh Miller27

Curved vs Straight Blade

28Visualization of Vocal Cords

TongueEpiglottisVocalcordGlotticopeningArytenoidcartilageVallecula

29

30Difficult IntubationL= Look ExternallyE= Evaluate the 3-3-2 RuleM= MallampatiO= ObstructionN= Neck Mobility

Cricothyrotomy

TracheostomyIndications for Tracheostomy

Inability to maintain a patent airwaySuspected cervical spine instability (percutaneous technique only)Prevention of damage to vocal cords and (possibly) subglottic stenosisAbnormal anatomy (percutaneous only)Upper airway obstructionHigh inotrope or ventilatory requirement (relative)Requirement for tracheobronchial toilet with suctioningPart of larger surgical procedure (e.g., laryngectomy)

Contraindications to Tracheostomy

Prolonged orotracheal or nasotracheal intubationLocal inflammationFailure to wean from ventilationBleeding disorder (relative)Absence of protective airway reflexesArterial bleeding in neck/upper thorax

Benefits ComfortReduced need for sedationImproved weaning from ventilationImproved ability to suction tracheaPrevention of ulceration of lips and tongue or healing of such ulcersReduced upper airway injuryPotential for speech and oral nutrition

Complications Misplacement of tubePrimary hemorrhagePneumothorax or tension pneumothorax; hemothoraxSurgical emphysemaInfectionLate hemorrhageerosion of innominate (or other) vesselsTracheoesophageal fistula

Esophageal-Tracheal Combitube

EDistal EndACHGDBFProximal EndA = esophageal obturator; ventilation into trachea through side openings = B C = tracheal tube; ventilation through open end if proximal end inserted in tracheaD = pharyngeal cuff; inflated through catheter = EF = esophageal cuff; inflated through catheter = GH = teeth marker; blindly insert Combitube until marker is at level of teeth 39Esophageal-Tracheal Combitube

40Providing Ventilatory SupportMouth to Mouth / NoseMouth to MaskBag MaskIndependent Lung Ventilation (ILV)Positive End-Expiratory Pressure (PEEP)Continuous Positive Airway Pressure (CPAP)