introduction to management

1. Oxygen Delivery Devices
and Airway Management
Selam Tebeje (MD)
Anesthesiology
1

2. 2

3. Face Mask
Nasal Prongs
Non-Rebreather
So what FiO2 is my patient getting?
3

4. Nasal Prongs
Litres per minute
Approximate
FiO2*
1 24%
2 28%
3 32%
4 36%
5 40%
6 44%
*Estimate only – highly variable. Will be
lower if patient has high inspiratory flow
rate or mouth breathes
4

5. Simple Face Mask
• Flow rates 5-10 L/min
• Flows below 5 L not recommended
– (may lead to CO2 rebreathing)
• May provide FiO2 up to about 60%
• No real advantage over nasal prongs
and not as comfortable so not usually
used
5

6. Non-Rebreathers
• Flow rate 10-15 L/min
• FiO2 up to 90%
• Uses reservoir bag to
increase FiO2
6

7. INTUBATION ???
11/10/2023 AGHMC 7

8. FACE MASK
(TYPES)
1. Open type
• Has additional holes in the mask to allow expired
gases to escape
• Does not require a tight seal
11/10/2023 AGHMC 8

9. FACE MASK
(TYPES)
2 .Closed type
• Designed to provide a complete seal around
the patient mouth and nose
• PPV
• Resuscitation
11/10/2023 AGHMC 9

10. Face mask
(techniques of use)
• appropriate size
• Upper part should sit over the bridge of nose
• The side should seal just lateral to the naso-
labial folds
• The bottom b/n lower lip and chin
11/10/2023 AGHMC 10

11. Simple maneuvers to overcome UAO,
excluding intubation
• Clearing the airway – secretion/FB
• ?Head tilt??/ chin lift/jaw trust maneuvers
• Oral/nasal airway
• Positioning patient on their side in semi-prone
position – recovery position
11/10/2023 AGHMC 11

12. • Sniffing position
– Airway anatomy
• 3 axis
– Cervical flexion
• Larynx/pharynx
– Head extension at AO
joint
• Larynx/oral
cavity/pharynx
AIRWAY MANAGEMENT and
positioning
11/10/2023 AGHMC 12

13. Sniff Position
OA = oral axis, PA = pharyngeal axis, LA = laryngeal axis
11/10/2023 AGHMC 13

14. 11/10/2023 AGHMC 14

15. Face mask
(techniques of use)
• The most effective way of opening the air way
is applying a jaw thrust
• A one handed technique
• Two handed technique
11/10/2023 AGHMC 15

16. A one handed technique,
(the C seal & E lift)
11/10/2023 AGHMC 16

17. Two handed technique
( Esmarch-Heiberg maneuver)
11/10/2023 AGHMC 17

18. Oral Airways
• An oral or nasal airway decreases the work of
breathing during spontaneous breathing via
face mask by maintaining patency
• Unlike other maneuvers, cervical spine
movement does not occur when an airway is
inserted

19. • lifts the tongue and epiglottis away from the
posterior pharyngeal wall and prevent them
from obstructing the space above the larynx.
11/10/2023 AGHMC 19

20. Oral airway insertion

21. Breathing/ventilation
• BMV
– Avoid pressure trauma to the
face/eyes
• Rate-normal
• Synchronized with patients
effort
11/10/2023 AGHMC 21

22. INTUBATION ???
11/10/2023 AGHMC 22

23. Objective criteria for intubation
oxygenation Pao2 < 70mm Hg Fio2=70%
A-a Do2 > 350 mm Hg
Needs ABG analysis
ventilation RR > 35, < 5
Paco2 > 60
PH < 7.20 (acidosis)
Mechanics VC < 15 ml/kg( normal VC =70Ml/kg=
5 L)
VT < 5 ml/kg
NIF > -25cmH20
spirometry
11/10/2023 AGHMC 23

24. Subjective criteria for intubation
• 1. Airway protection
• ↓ level of consciousness, GCS < 8
• Drug over dose/poisoning, trauma
• 2.clinical sign of respiratory faillure
• Diaphoresis ,tachypnea , tachycardia, accessory Ms use,
cyanosis,…..
• 3.shock – not reversed with medical Tx( in the
1st 35-45 min)
11/10/2023 AGHMC 24

25. • 4. Impending airway obstruction
– Epiglotitis, severe croup, thermal burns,tumor…
11/10/2023 AGHMC 25