Airway adjuncts and management in ACLS


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techniques to manage airway during cardiac arrest

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  • Airway adjuncts and management in ACLS

    1. 1. ADJUNCTS FORAIRWAY CONTROL, VENTILATION AND SUPPLEMENTAL OXYGEN Objectives1. To control the airway properly during cardiac arrest2. To optimize ventilation3. To use airway adjuncts properly and effectively4. To provide supplemental oxygen properly and effectively
    2. 2. 1Open airwayby
    3. 3. OPEN AIRWAY ( Head - tilt / chin - lift / jaw - thrust ) No respirations Spontaneous respirations present present VENTILATE WITH KEEP AIRWAY OPEN SUPPLEMENTAL OXYGEN AND MONITOR PATIENT Mouth-to-Mask, B-V-M No chest expansion INSERT PHARYNGEAL AIRWAY (oral or nasal) Foreign body obstruction VENTILATEENDOTRACHEAL INTUBATION (as soon as possible)
    4. 4. AIRWAY CONTROL Airway Obstruction •Tongue and/or •Epiglottis
    5. 5. AIRWAY CONTROL Opening the AirwayJaw thrust Head tilt–chin lift
    6. 6. AIRWAY CONTROL Oropharyngeal Airway
    7. 7. AIRWAY CONTROLOropharyngeal Airway (cont.)
    8. 8. AIRWAY CONTROLOropharyngeal Airway (cont.)
    9. 9. AIRWAY CONTROLOropharyngeal Airway (cont.)
    10. 10. AIRWAY CONTROLOropharyngeal Airway (cont.)
    11. 11. AIRWAY CONTROLNasopharyngeal Airway
    12. 12. AIRWAY CONTROLNasopharyngeal Airway (cont.)
    13. 13. AIRWAY CONTROLNasopharyngeal Airway (cont.)
    14. 14. ENDOTRACHEAL INTUBATION Advantages• Protection of the airway from aspiration of foreign material• Facilitates ventilation and oxygenation• Facilitates suctioning of trachea and bronchi• Provides route for drug administration• Prevents gastric insufflation• Allows faster rate of chest compression
    15. 15. ENDOTRACHEAL INTUBATION Indications• Inability to ventilate the unconscious patient• After insertion of pharyngeal airway• Inability of patient to protect own airway (coma, areflexia, or cardiac arrest)• Need for prolonged artificial ventilation
    16. 16. ENDOTRACHEAL INTUBATION Equipment • Laryngoscope with several blades • Endotracheal tubes • Malleable stylet • 10-ml syringe • Magill forceps • Water soluble lubricant • Functional suction unit
    17. 17. ENDOTRACHEAL INTUBATION Laryngoscope & Blades
    18. 18. ENDOTRACHEAL INTUBATION Laryngoscope (cont.) Connection of blade to handle
    19. 19. ENDOTRACHEAL INTUBATION Endotracheal tube
    20. 20. ENDOTRACHEAL INTUBATION Endotracheal tube (cont.) Stylet
    21. 21. ENDOTRACHEAL INTUBATION Aligning Axes of Upper Airway Mouth A A B B C C Pharynx Trachea Extend-the-head-on-neck (“look up”): aligns axis A relative to B Flex-the-neck-on-shoulders (“look down”): aligns axis B relative to C
    26. 26. ENDOTRACHEAL INTUBATION Recommendations• Intubate as soon as possible after ventilation and oxygenation, in cardiac arrest• Intubation should be done by most experienced person• Do not take longer than 30 seconds• Auscultate the thorax and epigastrium after intubation
    27. 27. ENDOTRACHEAL INTUBATION Complications • Trauma-teeth, lips, tongue, mucosa, vocal cords, trachea • Esophageal intubation • Vomiting and aspiration • Hypertension and arrhythmias
    28. 28. OXYGENATION AND VENTILATION Mouth-to-mask Advantages • Elimination of direct contact • Adequate lung ventilation • Enriched oxygen mixture • Easier than bag-valve-mask
    29. 29. OXYGENATION AND VENTILATION Mouth-to-mask (cont.) Mouth-to-mask device
    30. 30. OXYGENATION AND VENTILATION Mouth-to-mask (cont.) Technique
    31. 31. OXYGENATION AND VENTILATION Bag-Valve-Mask Advantages • Provides immediate ventilation and oxygenation • Sense of compliance and airway resistance conveyed to operator • Ideal method of ventilation after intubation • High oxygen concentrations are possible • Can be used with spontaneous respirations
    32. 32. OXYGENATION AND VENTILATION Bag-Valve-Mask (cont.) With oxygen reservoir
    33. 33. OXYGENATION AND VENTILATION Bag-Mask Ventilation • Key—ventilation volume: “enough to produce obvious chest rise” 1-Person: 2-Person: difficult, less effective easier, more effective
    34. 34. OXYGENATION AND VENTILATION Bag-Valve-Mask (cont.) Complications • Inadequate tidal volumes leading to hypoventilation • Gastric distension
    35. 35. OXYGENATION AND VENTILATION Manually Triggered Oxygen Powered Breathing Device • Allow for positive pressure ventilation • Deliver 100% oxygen concentration • Should provide a constant flow at 40 L/min • Should have a relief valve that opens at 60 cmH2O
    37. 37. TRACHEOBRONCHIAL SUCTIONING Techniques • Check equipment • Set pressure between –80 to –120 mmHg • Pre-oxygenate with 100% O2 for five minutes • Use sterile technique • Insert suction catheter through the tube • Apply suction and remove the catheter with a rotation motion • Suction no longer than 10 seconds
    38. 38. OTHER ADJUNCTS & TECHNIQUES Cricoid Pressure
    39. 39. Esophageal-Tracheal Combitube A = esophageal obturator; ventilation into trachea through side openings = B E C = tracheal tube; ventilation through open end if proximal end inserted in trachea D = pharyngeal cuff; inflated through catheter = EDistal End F = esophageal cuff; inflated through catheter = G H = teeth marker; blindly insert Combitube until marker is at level of teeth A C H Proximal End B D F G
    40. 40. Esophageal-Tracheal Combitube Inserted in Esophagus A H D D B FA = esophageal obturator; ventilation into trachea through side openings = BD = pharyngeal cuff (inflated)F = inflated esophageal/tracheal cuffH = teeth markers; insert until marker lines at level of teeth
    41. 41. Laryngeal Mask Airway (LMA)The LMA is an adjunctive airway that consists of atube with a cuffed mask-like projection at distal end.
    42. 42. LMA Introduced Through Mouth Into Pharynx
    43. 43. LMA in PositionOnce the LMA is in position, a clear, secure airway is present.
    44. 44. Anatomic Detail
    45. 45. Esophageal Detector Device (Bulb-Type)
    46. 46. Confirmation:Tracheal Tube Placement End-tidal colorimetric CO2 indicators
    47. 47. Tracheal Tube Holders: Adult and Infant
    48. 48. Colorimetric End-Tidal CO2 Detector
    49. 49. End-Tidal CO2 Detectorconnected to Bag-valve-mask