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management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
management of airway
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management of airway

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  • 1. www.hi-dentfinishingschool.blogspot.com
  • 2. management of airway
  • 3.  
  • 4. Anatomy <ul><li>Nose </li></ul><ul><li>Pharynx </li></ul><ul><li>Larynx </li></ul><ul><li>Trachea </li></ul>
  • 5. Nose <ul><li>Warming and humidification. </li></ul><ul><li>The resistance of airflow through nasal passages = 2/3 total airway resistance. </li></ul><ul><li>The resistance with mouth opening = 1/2 the resistance through nose. </li></ul><ul><li>Exercise  mouth breathing. </li></ul>
  • 6. Pharynx <ul><li>Nasopharynx: tonsil </li></ul><ul><li>Oropharynx: tongue (tone of genioglossus muscle) </li></ul><ul><li>Hypopharynx </li></ul>
  • 7. Larynx <ul><li>Lie at the level of C3~C5,6 </li></ul><ul><li>Phonation and glottic closure reflex </li></ul><ul><li>Cartilage, muscle, ligament </li></ul>
  • 8.  
  • 9.  
  • 10. Trachea <ul><li>Lie at the level of C6 (thyroid cartilage)~T5 (carina) </li></ul><ul><li>10~15 cm in length; 16~20 horseshoe-shaped cartilaginous rings. </li></ul><ul><li>Stretch receptor and irritant (cough) receptor. </li></ul>
  • 11. Evaluation of the Airway <ul><li>History </li></ul><ul><li>PE </li></ul><ul><li>Further evaluation: CXR, C-spine film, CT, MRI. </li></ul>
  • 12. <ul><li>Conditions that predispose to a difficult airway include: </li></ul><ul><li>Infections : epiglottitis, abscesses, croup, bronchitis, pneumonia. </li></ul><ul><li>Trauma </li></ul><ul><li>maxillofacial trauma, cervical spine injury, laryngeal injury. </li></ul><ul><li>Endocrine : morbid obesity, diabetes mellitus, acromegaly. </li></ul><ul><li>Foreign Body </li></ul><ul><li>Inflammatory Conditions </li></ul><ul><li>ankylosing spondylitis, rheumatoid arthritis. </li></ul><ul><li>Tumors : upper and lower airway tumors. </li></ul><ul><li>Congenital Problems </li></ul><ul><li>choanal atresia, tracheomalacia, cleft palate, Pierre Robin </li></ul><ul><li>syndrome, Treacher Collins syndrome, Hallermann-Streiff </li></ul><ul><li>syndrome. </li></ul><ul><li>Physiologic Conditions : pregnancy. </li></ul>
  • 13. <ul><li>PE </li></ul><ul><li>Nostril size and patency. </li></ul><ul><li>Beard, teeth. </li></ul><ul><li>Mouth opening (Temporo-mandibular joint). </li></ul><ul><li>Tongue, incisors. </li></ul><ul><li>Mallampati classification. </li></ul><ul><li>Thyromental distance. </li></ul><ul><li>Neck mobility--lower C-spine flexion, higher C-spine extension (atlanto-occipital joint). </li></ul>
  • 14. Mallampati classification
  • 15.  
  • 16. Upper Airway Obstruction <ul><li>Complete UAO: rapidly progressing series of events </li></ul><ul><li>patient is unable to breathe, speak, or cough and may hold the throat between the thumb and index finger (the universal choking sign) </li></ul><ul><li>anxious and agitated. Vigorous attempts at respiration with intercostal and supraclavicular retraction. Heart rate and blood pressure raised Patient becomes rapidly cyanosed </li></ul><ul><li>respiratory efforts diminish, loss of consciousness, bradycardia and hypotension </li></ul><ul><li>cardiac arrest </li></ul><ul><li>death is inevitable if the obstruction is not relieved within 2-5 minutes of the onset </li></ul>
  • 17. <ul><li>Partial UAO: stable, or progressive deterioration </li></ul><ul><li>signs and symptoms may be mild but as they worsen include coughing, inspiratory stridor, crowing or noisy respiration, dysphonia, aphonia, choking, drooling and gagging </li></ul><ul><li>dyspnoea, feeble cough, respiratory distress and signs of hypoxaemia and hypercarbia such as anxiety, confusion, lethargy and cyanosis may be present as the obstruction worsens </li></ul><ul><li>powerful inspiratory efforts against an obstruction may produce dermal ecchymoses and subcutaneous emphysema. Partial airway obstruction that is worsening should be aggressively managed and if rapidly progressing immediate preparation for treatment as complete obstruction should be made (see Figures 1 and 2) </li></ul>
  • 18. Aetiology <ul><li>Functional causes </li></ul><ul><li>CNS depression </li></ul><ul><li>Peripheral nervous system and neuromuscular abnormalities </li></ul><ul><li>- Recurrent laryngeal nerve interruption </li></ul><ul><li>(postoperative, inflammatory, tumour infiltration)), - obstructive sleep apnoea - laryngospasm - myasthenia gravis - Guillain-Barre polyneuritis - hypocalcaemia (causing vocal cord spasm). - tetanus </li></ul>
  • 19. <ul><li>Mechanical causes </li></ul><ul><li>Foreign body aspiration </li></ul><ul><li>Infections </li></ul><ul><li>epiglottitis; supraglottitis ; retropharyngeal cellulitis or abscess; parapharyngeal abscess; Ludwig’s angina; </li></ul><ul><li>diphtheria; bacterial tracheitis laryngotracheobronchitis </li></ul><ul><li>Laryngeal oedema: allergic; hereditary angioedema </li></ul><ul><li>Haemorrhage and haematoma : post operative </li></ul><ul><li>anticoagulation therapy </li></ul><ul><li>coagulopathy </li></ul><ul><li>Trauma, Burns, Neoplasm </li></ul><ul><li>Congenital: vascular rings; laryngeal webs, laryngocoele </li></ul><ul><li>Miscellaneous: crico-arytenoid arthritis </li></ul><ul><li>achalasia of the oesophagus </li></ul><ul><li>hysterical stridor, myxoedema </li></ul>
  • 20.  
  • 21. Maintain Airway <ul><li>Open the airway: head tilt, chin lift, jaw thrust. </li></ul><ul><li>Suction: 100% O2 supplement; less than 15 seconds. </li></ul><ul><li>Adjuvant airway: oropharyngeal airway </li></ul><ul><li>nasopharyngeal airway </li></ul><ul><li>Bag-valve-mask </li></ul><ul><li>Intubation </li></ul><ul><li>Surgical airway </li></ul>
  • 22. Guedel Airway
  • 23. <ul><li>Oropharyngeal airway </li></ul><ul><li>for use in unconscious </li></ul><ul><li>(unresponsive) </li></ul><ul><li>patients with no cough </li></ul><ul><li>or gag reflex. </li></ul>
  • 24. <ul><li>Nasopharyngeal airway </li></ul><ul><li>for condition such as </li></ul><ul><li>clenched jaw; better </li></ul><ul><li>tolerated than oral </li></ul><ul><li>airways in p’ts who are </li></ul><ul><li>not deeply unconscious; </li></ul><ul><li>30% bleeding; </li></ul><ul><li>craniofascial injury </li></ul>
  • 25.  
  • 26.  
  • 27. Resuscitator
  • 28. Combi tube
  • 29. size 1 up to 5 kg (4 ml); size 1.5 , 5 ~ 10 kg (7 ml) size 2 , 10 to 20 kg (10 ml) size 2.5 , 20 ~ 30 kg (14 mL) size 3 , children or small adults weighing more than 30 kg (20 mL); size 4, normal and large adults (30 mL); size 5 , large adults (40 mL).
  • 30.  
  • 31.  
  • 32. Indications for tracheal intubation ---Airway protection. ---Maintenance of patent airway. ---Pulmonary toilet. ---Application of positive-pressure ventilation. ---Maintenance of adequate oxygenation. ---Predictable FIO 2 . --- Positive end-expiratory pressure.
  • 33. <ul><li>Straight: </li></ul><ul><li>provide excellent exposure of the glottic opening </li></ul><ul><li>Curved: </li></ul><ul><li>good view of oropharynx and hypopharynx, thus allow more room for ETT passage with decreased epiglottis trauma </li></ul>
  • 34.  
  • 35.  
  • 36. Cuff pressures that afford good (but not perfect) protection (20 to 25 mm Hg) are just below the perfusion pressure of the tracheal mucosa (25 to 35 mm Hg). Endotracheal tube leak pressure is a clinically useful way to fit or confirm proper selection of uncuffed tube size in children. Leak should occur at 15 to 20 cm H2 O pressure. <ul><li>Sellick maneuver: BURP (backward; upward; rightward; pressure) </li></ul><ul><li>30 sec </li></ul>
  • 37. <ul><li>Difficult tracheal intubation accounts for 17% of the respiratory-related injury and results in significant cost morbidity and mortality. In fact, up to 28% of all deaths associated with anesthesia are due to the inability to mask ventilate or intubate. </li></ul>
  • 38. <ul><li>Other complications of difficult tracheal intubation include the </li></ul><ul><li>following: </li></ul><ul><li>Laceration of soft tissues. </li></ul><ul><li>Laryngospasm. </li></ul><ul><li>Vocal cord paralysis. </li></ul><ul><li>Dislocation of the arytenoid cartilages or mandible. </li></ul><ul><li>Perforation of the trachea or the esophagus. </li></ul><ul><li>Endobronchial or esophageal intubation. </li></ul><ul><li>Dental damage. </li></ul><ul><li>Hemorrhage. </li></ul><ul><li>Aspiration of gastric contents or foreign bodies. </li></ul><ul><li>Increased intracranial or intraocular pressure. </li></ul><ul><li>Hypoxemia, hypercarbia. </li></ul><ul><li>Fracture or dislocation of the cervical spine. </li></ul><ul><li>Spinal cord damage. </li></ul><ul><li>Trauma to the eyes. </li></ul>

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