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O X Y G E N AT I O N T H E R A P Y
A N D
A I R W AY A D J U N C T S ( B A S I C
A N D A D VA N C E D )
Ahmad Thanin
O B J E C T I V E S
To develop their skills on maintaining patient’s airway open and patent.
To determine the appropriate device to be used for oxygenation according to patients’
needs.
To learn the different methods of airway adjuncts insertion.
To be familiar with the commonly used advance airways introduced by the Saudi Heart
Association.
To learn the technique of Intubation Skills and understand the indications and
advantages of it.
T I M E I S C R I T I C A L . .
B A S I C L I F E S U P P O R T
A I R W AY M A N E U V E R S
H E A D T I LT A N D C H I N L I F T
M A N E U V E R
J A W T H R U S T
M A N E U V E R
O X Y G E N T H E R A P Y A N D D E L I V E R Y
D E V I C E S
O X Y G E N C Y L I N D E R N A S A L C A N N U L A
O X Y G E N T H E R A P Y A N D D E L I V E R Y
D E V I C E S
S I M P L E FA C E M A S K N O N - R E B R E AT H E R M A S K
O X Y G E N T H E R A P Y A N D D E L I V E R Y
D E V I C E S
V E N T U R I M A S K
V E N T I L AT I O N D E V I C E S
P O C K E T M A S K B A G - VA LV E - M A S K - D E V I C E
B A S I C
A I R W AY
A D J U N C T S
OROPHARYNGEAL
AIRWAY
• Direct Method
• Indirect Method Tongue
Depressor Technique
INDICATIONS
• Unconscious patient
• No gag reflex
O R O P H A R Y N G
E A L A I R W AY
B A S I C
A I R W AY
A D J U N C T S
NASOPHARYNGEAL
AIRWAY
• Semi-conscious patient
• Gag reflex still present
• Oropharyngeal airway is
technically difficult due to
massive trauma around the
mouth, mandibulo-maxillary
wiring and trismus.
INDICATIONS
N A S O P H A R Y N G
E A L A I R W AY
A D VA N C E D A I R W AY S
COMBITUBE
LMA
(LARYNGEAL
MASK AIRWAY)
ENDOTRACHEAL
TUBE
I N D I C AT I O N S
Difficult Intubation
Rapid maintenance of airway
Trauma cases with suspected neck injury
When endotracheal intubation is not possible due to the shape of the patient’s neck/larynx.
Can be used for difficult intubation for anesthesia.
C O M B I T U B E
Sizes:
• 41 – Male (100ml/15ml)
• 37 – Female(85ml/12ml)
L A R Y N G E A L
M A S K A I R W AY
Sizes:
• 1 – Neonatal to 6.5 kg ( 5ml)
• 2 – 6.5 kg to 20 kg (10ml)
• 3 – 20kg to 30 kg (15ml)
• 4 – 30 kg up to small adult ( 20ml)
• 5 – Normal Adult (30ml)
• 6 – Large Adult ( 40ml)
I N D I C A T I O N S F O R E N D O T R A C H E A L
I N T U B A T I O N :
Cardiopulmonary Arrest
Patient in deep coma or unresponsive
Shallow or slow respirations (less than 8 per minute)
Progressive cyanosis
Surgical patients where body positioning or facial contours preclude the use of a mask
To prevent loss of airway later
E N D O T R A C H E A L T U B E A N D
L A R Y N G O S C O P E S I Z E S :
Age Preemie Neonate 6
Months
1 -2
Years
4 – 6
Years
8 – 12
Years
Adult
Tube
Size
2.5 3 – 3.5 3.5 – 4 4 – 5 5 – 5.5 6 – 7 7.5 – 8.5
Blade
Size
0 0 – 1 1 1 – 2 2 2 – 3 4 – 5
E Q U I M E N T
F O R
I N T U B AT I O N
Suction machine
Airway
Laryngoscope
Tube (Endotracheal
tube)
A D D I T I O N A L
E Q U I P M E N T
10 ml syringe
Stylet
Magill’s forceps
Water soluble jelly
Stethoscope
Ambu Bag
Xylocaine Spray
T Y P E S O F L A R Y N G O S C O P E :
M A C I N T O S H M I L L E R
D I A G R A M O F A N E N D O T R A C H E A L
T U B E T H AT H A S B E E N I N S E R T E D
I N T O T H E T R A C H E A :
A. Endotracheal tube (blue).
B. Cuff inflation tube with pilot balloon.
C. Trachea.
D. Esophagus
I N T U B AT I O N P R O C E D U R E S
Ventilate at rate of 20 or
greater per min for 1-2
min or pre-oxygenate the
patient 100% of oxygen.
1
Hold laryngoscope with
left hand and Insert
Laryngoscope blade into
the right side of mouth
and sweep tongue to the
left
2 Visualize vocal cords 3
Insert ET Tube through
cords, stop at black line
4
If adult, inflate cuff with
up to 10-15ml of air
5
Disconnect syringe,
remove stylet
6
Ventilate patient through
tube and confirm breath
sounds over 4 lung fields
and epigastrium
7
If Tube is placed properly,
secure Tube in place
I N T U B AT I O N R E M I N D E R S
Ventilate at rate of 20 or greater per min for 1-2 min or pre-oxygenate the patient of 100% oxygen.
Ventilation rate 1 ventilation every 6-8 seconds (8-10 per minute)
You have 30 seconds (From the time of the last ventilation until the resumption of ventilations)
Don’t pry on the teeth
Visualize cords (the best confirmation)
Don’t forget to inflate the cuff with up to 10-15ml of air
Listen at 5 fields to confirm (stomach, right, left, upper and lower)
C H E C K L I S T O F
S U C C E S S F U L
I N T U B AT I O N
• Good breath sounds in both lung.
• Bilateral Chest Expansion.
• Absence of gurgling sounds in the stomach.
• No abdominal Distention
• End-tidal Carbon dioxide Monitoring.
• X-ray
• Esophageal Detector Device
M E D I C AT I O N S T H AT C A N B E G I V E N
T H R O U G H E N D O T R A C H E A L T U B E
Epinephrine Lidocaine
Vasopressin Atropine
T H A N K Y O U

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Oxygen therapy and airway adjuncts

  • 1. O X Y G E N AT I O N T H E R A P Y A N D A I R W AY A D J U N C T S ( B A S I C A N D A D VA N C E D ) Ahmad Thanin
  • 2. O B J E C T I V E S To develop their skills on maintaining patient’s airway open and patent. To determine the appropriate device to be used for oxygenation according to patients’ needs. To learn the different methods of airway adjuncts insertion. To be familiar with the commonly used advance airways introduced by the Saudi Heart Association. To learn the technique of Intubation Skills and understand the indications and advantages of it.
  • 3. T I M E I S C R I T I C A L . .
  • 4. B A S I C L I F E S U P P O R T
  • 5. A I R W AY M A N E U V E R S H E A D T I LT A N D C H I N L I F T M A N E U V E R
  • 6. J A W T H R U S T M A N E U V E R
  • 7. O X Y G E N T H E R A P Y A N D D E L I V E R Y D E V I C E S O X Y G E N C Y L I N D E R N A S A L C A N N U L A
  • 8. O X Y G E N T H E R A P Y A N D D E L I V E R Y D E V I C E S S I M P L E FA C E M A S K N O N - R E B R E AT H E R M A S K
  • 9. O X Y G E N T H E R A P Y A N D D E L I V E R Y D E V I C E S V E N T U R I M A S K
  • 10. V E N T I L AT I O N D E V I C E S P O C K E T M A S K B A G - VA LV E - M A S K - D E V I C E
  • 11. B A S I C A I R W AY A D J U N C T S OROPHARYNGEAL AIRWAY • Direct Method • Indirect Method Tongue Depressor Technique INDICATIONS • Unconscious patient • No gag reflex
  • 12. O R O P H A R Y N G E A L A I R W AY
  • 13. B A S I C A I R W AY A D J U N C T S NASOPHARYNGEAL AIRWAY • Semi-conscious patient • Gag reflex still present • Oropharyngeal airway is technically difficult due to massive trauma around the mouth, mandibulo-maxillary wiring and trismus. INDICATIONS
  • 14. N A S O P H A R Y N G E A L A I R W AY
  • 15. A D VA N C E D A I R W AY S COMBITUBE LMA (LARYNGEAL MASK AIRWAY) ENDOTRACHEAL TUBE
  • 16. I N D I C AT I O N S Difficult Intubation Rapid maintenance of airway Trauma cases with suspected neck injury When endotracheal intubation is not possible due to the shape of the patient’s neck/larynx. Can be used for difficult intubation for anesthesia.
  • 17. C O M B I T U B E Sizes: • 41 – Male (100ml/15ml) • 37 – Female(85ml/12ml)
  • 18. L A R Y N G E A L M A S K A I R W AY Sizes: • 1 – Neonatal to 6.5 kg ( 5ml) • 2 – 6.5 kg to 20 kg (10ml) • 3 – 20kg to 30 kg (15ml) • 4 – 30 kg up to small adult ( 20ml) • 5 – Normal Adult (30ml) • 6 – Large Adult ( 40ml)
  • 19. I N D I C A T I O N S F O R E N D O T R A C H E A L I N T U B A T I O N : Cardiopulmonary Arrest Patient in deep coma or unresponsive Shallow or slow respirations (less than 8 per minute) Progressive cyanosis Surgical patients where body positioning or facial contours preclude the use of a mask To prevent loss of airway later
  • 20. E N D O T R A C H E A L T U B E A N D L A R Y N G O S C O P E S I Z E S : Age Preemie Neonate 6 Months 1 -2 Years 4 – 6 Years 8 – 12 Years Adult Tube Size 2.5 3 – 3.5 3.5 – 4 4 – 5 5 – 5.5 6 – 7 7.5 – 8.5 Blade Size 0 0 – 1 1 1 – 2 2 2 – 3 4 – 5
  • 21.
  • 22. E Q U I M E N T F O R I N T U B AT I O N Suction machine Airway Laryngoscope Tube (Endotracheal tube)
  • 23. A D D I T I O N A L E Q U I P M E N T 10 ml syringe Stylet Magill’s forceps Water soluble jelly Stethoscope Ambu Bag Xylocaine Spray
  • 24. T Y P E S O F L A R Y N G O S C O P E : M A C I N T O S H M I L L E R
  • 25. D I A G R A M O F A N E N D O T R A C H E A L T U B E T H AT H A S B E E N I N S E R T E D I N T O T H E T R A C H E A : A. Endotracheal tube (blue). B. Cuff inflation tube with pilot balloon. C. Trachea. D. Esophagus
  • 26. I N T U B AT I O N P R O C E D U R E S Ventilate at rate of 20 or greater per min for 1-2 min or pre-oxygenate the patient 100% of oxygen. 1 Hold laryngoscope with left hand and Insert Laryngoscope blade into the right side of mouth and sweep tongue to the left 2 Visualize vocal cords 3 Insert ET Tube through cords, stop at black line 4 If adult, inflate cuff with up to 10-15ml of air 5 Disconnect syringe, remove stylet 6 Ventilate patient through tube and confirm breath sounds over 4 lung fields and epigastrium 7 If Tube is placed properly, secure Tube in place
  • 27. I N T U B AT I O N R E M I N D E R S Ventilate at rate of 20 or greater per min for 1-2 min or pre-oxygenate the patient of 100% oxygen. Ventilation rate 1 ventilation every 6-8 seconds (8-10 per minute) You have 30 seconds (From the time of the last ventilation until the resumption of ventilations) Don’t pry on the teeth Visualize cords (the best confirmation) Don’t forget to inflate the cuff with up to 10-15ml of air Listen at 5 fields to confirm (stomach, right, left, upper and lower)
  • 28. C H E C K L I S T O F S U C C E S S F U L I N T U B AT I O N • Good breath sounds in both lung. • Bilateral Chest Expansion. • Absence of gurgling sounds in the stomach. • No abdominal Distention • End-tidal Carbon dioxide Monitoring. • X-ray • Esophageal Detector Device
  • 29. M E D I C AT I O N S T H AT C A N B E G I V E N T H R O U G H E N D O T R A C H E A L T U B E Epinephrine Lidocaine Vasopressin Atropine
  • 30. T H A N K Y O U