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Airway Evaluation and Management

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Transcript

  • 1. Airway Evaluation and Management
  • 2. Indications of intubation
    • Resuscitation (CPR)
    • Prevention of lung soiling
    • Positive pressure ventilation (GA)
    • Pulmonary toilet
    • Patent airway (coma or near coma)
    • Respiratory failure(CO2 retention )
  • 3. Requirement of successful intbatin
    • 1-Normal roomy mandible
    • 2-Normal T-M, A-O , and C-spine
  • 4. Requirements of successful intubation
    • 3-Alignment of 3 axes or
    • Assuming sniffing position
    • -Any anomaly in these 3 joints
    • A-O, T-M or C-spine can result
    • In difficult intubation
  • 5. Requirement of successful intubation
    • Proper equipment
    • -Bag and mask,oxygen source
    • -Airways oro and nasopharyngeal
    • -Laryngosopes different blades
    • -ETT different sizes
    • -suction on
  • 6. Airway gadgets
  • 7. Management
    • I-History:
    • previous history of difficulty is the best predictor
    • Inquire about:-Nature of difficulty
    • -No of trials
    • -Ability to ventilate bet trials
    • -Maneuver used
    • -Complications
    • II-Snoring and sleep apnea( prdictors of DMV)
  • 8. Examination
    • -Look for any obvious anomaly
    • Morbid obesity(BMI)
    • Skull
    • Face
    • Jaw
    • Mouth,teeth
    • Neck
  • 9. Examination
    • I-The 3 joints movements
    • A-O joint(15-20 degrees)
    • Presence of a gap bet the
    • Occiput and C1 is essential
    • The cervical spine(range>90)
    • T.M joint:-interdental gap(3 fingers)
    • -subluxation (1 finger)
  • 10. Examination
    • II-Measurements of the mandible
    • -Thyro-mental distance (head extended)
    • Normally 6.5 cm
    • Less than 6 cm=expect difficulty
  • 11. Tests to predict difficulty
    • Mallampatti test:
    • Based on the hypothesis
    • That when the base of the
    • Tongue is disproportionally
    • Large it will overshadow the
    • larynx
  • 12.
    • -Simple easy test,correlates with what is seen during laryngoscopy or Cormack-Lehene grades ,but
    • 1-moderate sensitivity and specificity(12% false +ve)
    • 2-Inter observer variation
    • 3-Phonation increases false negative view
  • 13. II-Wilson test
    • -Consists of 5 easily assessed factors
    • Body wight(n=0 ,>90=1,>110=2)
    • Head and neck movement
    • Jaw movement
    • Receding jaw
    • Buck teeth
    • Each factor assigned as o ,1 ,2 max is 10
  • 14. Difficult airway
    • Expected from history,examination
    • Secure airway while awake under LA
    • Unexpected different options
    • Priority for maintenance of patent airway and oxygenation
  • 15. Airway gadgets
  • 16.  
  • 17. Needle cricothyroidotomy
  • 18. Confirm tube position
    • Direct visualization of ETT between cords
    • Bronchoscopy ;carina seen
    • Continuous trace of capnography
    • 3 point auscultation
    • Esophageal detector device
    • Other as bilateral chest movement,mist in the tube,CXR
  • 19. Rapid sequence induction
    • Indications
    • Technique:
    • -Preoxygenation
    • -IV induction with sux
    • -Cricoid pressure
    • -Intubate, inflate the cuff ,confirm position
    • -Release cricoid and fix the tube
  • 20. Complications of intubation
    • 1-Inadequate ventilation
    • 2-Esophageal intubation
    • 3-Airway obstruction
    • 4-Bronchospasm
    • 5-Aspiration
    • 6- Trauma
    • 7-Stress response
  • 21. Recommendations
    • Adequate airway assessment to pick up expected D.A to be secured awake
    • Difficult intubation cart always ready
    • Pre oxygenation as a routine
    • Maintenance of oxygenation not the intubation should be your aim
    • Use the technique you are familiar with
    • Always have plan B,C,D in unexpected D.A