Airway lecture06122011

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Airway lecture06122011

  1. 1. AIRWAYMANAGEMENT ALS Subcommittee 2010
  2. 2. Learning and Skills Objectives• Describe the “airway hierarchy”• Be able to use airway devices• Understand the complications of these airway devices ALS Subcommittee 2010
  3. 3. “Airway hierarchy”– Oxygen delivering devices: • Nasal cannula • Face mask– Non-invasive airway devices: • Oropharyngeal airway • Nasopharyngeal airway • Pocket-mask device • Bag-mask device– Invasive airway devices: • Laryngeal mask airway (LMA) • Endotracheal tube (ETT) ALS Subcommittee 2010
  4. 4. “Airway hierarchy”– Oxygen delivering devices: • Nasal cannula • Face mask– Non-invasive airway devices: • Oropharyngeal airway • Nasopharyngeal airway • Pocket-mask device • Bag-mask device– Invasive airway devices: • Laryngeal mask airway (LMA) • Endotracheal tube (ETT) ALS Subcommittee 2010
  5. 5. Oxygen Delivering DevicesIn breathing patients who can protect his airway,conscious or unconscious Nasal cannula Simple face mask Venturi mask Mask with O2 reservoir 2010 ALS Subcommittee
  6. 6. “Airway hierarchy”– Oxygen delivering devices: • Nasal cannulae • Face masks– Non-invasive airway devices: • Oropharyngeal airway • Nasopharyngeal airway • Pocket-mask device • Bag-mask device– Invasive airway devices: • Laryngeal mask airway (LMA) • Endotracheal tube (ETT) ALS Subcommittee 2010
  7. 7. Oropharyngeal or Nasopharyngeal AirwayOnly in unconscious patient to prevent thetongue from falling backOropharyngeal airway Nasopharyngeal airway ALS Subcommittee 2010
  8. 8. Oropharyngeal and Nasopharyngeal Airway in Correct PositionOropharyngeal airway in Nasopharyngeal airway inplace in the mouth place in the nose ALS Subcommittee 2010
  9. 9. “Airway hierarchy”– Oxygen delivering devices: • Nasal cannulae • Face masks– Non-invasive airway devices: • Oropharyngeal airway • Nasopharyngeal airway • Pocket-mask device • Bag-mask device– Invasive airway devices: • Laryngeal mask airway (LMA) • Endotracheal tube (ETT) ALS Subcommittee 2010
  10. 10. Pocket-mask and Bag-maskTo ventilate patients non-invasively1-way valve ALS Subcommittee 2010
  11. 11. Bag-mask Ventilation1-hand technique for BVM 2-hand technique for BVM ALS Subcommittee 2010
  12. 12. “Airway hierarchy”– Oxygen delivering devices: • Nasal cannula • Face mask– Noninvasive airway devices: • Oropharyngeal airway • Nasopharyngeal airway • Pocket-mask device • Bag-mask device– Invasive airway devices: • Laryngeal mask airway (LMA) • Endotracheal tube (ETT) ALS Subcommittee 2010
  13. 13. Laryngeal Mask Airway (LMA)The LMA - a SUPRAGLOTTIC airway thatconsists of a tube with a cuffed mask-likeprojection at distal end ALS Subcommittee 2010
  14. 14. LMA - Indications• When mask ventilation fails to achieve adequate oxygenation• As an adjunct to airway management by personnel not skilled in tracheal intubation• As an adjunct to airway management by personnel skilled in tracheal intubation when endotracheal intubation is difficult or not successful ALS Subcommittee 2010
  15. 15. Insertion: Preparation• Choose the appropriate size• Recommended size guidelines: – Size 1: < 5 kg – Size 1.5: 5 - 10 kg – Size 2: 10 - 20 kg – Size 2.5: 20 - 30 kg – Size 3: 30 - 50 kg – Size 4: 50 – 70 kg – Size 5: >70 kg ALS Subcommittee 2010
  16. 16. LMA in place in the Mouth ALS Subcommittee 2010
  17. 17. Complications of LMA Sore throat Dysphagia Dryness of the throat and/or mucosa Tongue cyanosis Vocal cord paralysis Major: Aspiration ALS Subcommittee 2010
  18. 18. “Airway hierarchy”– Oxygen delivering devices: • Nasal cannula • Face mask– Noninvasive airway devices: • Oropharyngeal airway • Nasopharyngeal airway • Pocket-mask device • Bag-mask device– Invasive airway devices: • Laryngeal mask airway (LMA) • Endotracheal tube (ETT) ALS Subcommittee 2010
  19. 19. CONTROL OF THE AIRWAY WITH ENDOTRACHEAL TUBE IS USUALLY REGARDED AS THE “GOLD STANDARD”limited to trained and skilled personnel ALS Subcommittee 2010
  20. 20. Endotracheal Intubation Weigh benefit of intubation VS adverse effect of interrupting chest compressions during intubation Intubation should be done by most experienced person Do not take longer than 30 seconds per attempt ALS Subcommittee 2010
  21. 21. Curved Blade Attached to Laryngoscope Handle ALS Subcommittee 2010
  22. 22. Aligning Axes of Upper Airway MouthA 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 ALS Subcommittee 2010
  23. 23. Cricoid Pressure Thyroid Cartilage Cricoid ALS Subcommittee 2010
  24. 24. Visualization of Vocal Cords Anatomy Tongue Vallecula Epiglottis Vocal cord Glottic Arytenoid opening cartilage ALS Subcommittee 2010
  25. 25. Endotracheal IntubationComplications • Hypoxia – the act of intubation is an hypoxic event • Trauma—teeth, lips, tongue, mucosa, vocal cords, trachea • Vomiting and aspiration • Hypertension/hypotension and arrhythmias ALS Subcommittee 2010
  26. 26. Confirmation of advanced airway placement• Colour• Visible chest rise• Vapour in ETT• 5 points auscultation• Capnography / CO2 detector devices ALS Subcommittee 2010
  27. 27. THANK YOUNATIONAL COMMITTEE ON RESUSCITATION TRAINING SUBCOMMITEE FOR ADVANCED LIFE SUPPORT  Dr Tan Cheng Cheng  Dr Luah Lean Wah  Dr Ismail Tan bin Mohd Ali Tan  Dr Wan Nasrudin bin Wan Ismail  Dr Chong Yoon Sin  Dr Priya Gill  Dr Ridzuan bin Dato’ Mohd Isa  Dr Thohiroh binti Abdul Razak  Dr Adi bin Osman ALS Subcommittee 2010

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