This presentation is produced with lot of Deliberations for the customers of slide share

1. APROPRIATE AIRWAY
EQUIPMENT and TECHNIQUES
--Dr Nisar Ahmed Arain
-Assistant Professor
-Anesthesia/Critical care/ER

2. --Since CPR started in the early sixties,
It was meant to be only for basic Life
Support. As time went on
“Advanced Cardiac Life support”
developed and became an integral
part of the CPR
-OVER VIEW
-BASIC LIFE SUPPORT
-ADVANCED CARDIAC
LIFE SUPPORT

3. --1-Airway Management
--2-Basic Life support (BLS)
--3-Advanced Cardiac Life support (ACLS)
--4-Advanced Trauma Life support (ATLS)
--5-CPR in special situations
--6-Ethical issues
-CPR CONSISTS OF

4. AIRWAY
MANAGEMENT

5. -BASIC and ADVANCED
-AIRWAY MANAGEMENT

6. -OBJECTIVES
-AIRWAY MANAGEMENT
--1-Review airway anatomy
--2-Identify important anatomical structures
related to the intubation of a patient
--3-Review Basic airway maneuvers
--4-Review Blind insertion airways
--5-Review Advanced airway Techniques
--6-Describe the process of opening the
airway and maintaining it
--7-Describe the indications, limitations
proper sizing, and co-ordinations of
airway adjuncts

7. -AIRWAY MANAGEMENT
- OBJECTIVES contd.
--8-Identify indications for intubation and
prepare the necessary equipment
--9-Identify the advantages and disadvantages
of various devices for airway management
--10-Refresh working knowledge of intubation
equipment and airway support adjuncts
--11-Discuss supraglottic and Infraglottic airway
device (LMA and COMBITUBE)
--12-Identify difficult airway
--13-Idetify Equipment for difficult airway and
know their use

8. -OBJECTIVES contd.
-AIRWAY MANAGEMENT
--14-Discuss the ten commandments of airway management
--15-Review and demonstrate pediatric and adult Basic and
advanced airway Techniques
--16-Review Techniques for confirmation of tube placement
and ongoing monitoring
--17-Describe the indications, contraindications, advantages
complications and equipment for sedation procedures
during intubation
--18-Perform needle and surgical “crico-thyro-doctomy”
procedures

9. -CONTENTS
--1-INTRODUTION
a-To discuss Facts about airway
B-Procedure of airway Management
c-Initial inspection of airway without
tracheal intubation
d-Advanced airway management with
tracheal intubation
e-Management and Protection of airway
in patients with head trauma
f-Airway management and chest Trauma
--2-Summary

10. IT IS THE RSPONSIBILITY OF EVERY
HEALTH CARE PROVIDER TO MANAGE
A PATIENT’S AIRWAY IN THE MOST
EFFECTIVE WAY POSSIBLE
-AIRWAY MANAGEMENT

11. -What should we know about “Airway Management”
AIRWAY MANAGEMENT
--1-Airway anatomy and function
--2-Evaluation of airway
--3-Maitainence and ventilation
--4-Clinical Management of the airway
--5How to open the airway

12. --Airway control is vital to improve
pulmonary exchange as well as
to protect patient from aspiration.
--The most vital element in providing
functional respiration is the AIRWAY
-INTRODUCTION
-AIRWAY MANAGEMENT

13. -WHAT IS THE AIRWAY
-AIRWAY
MANAGEMENT
--1-The airway is the conduit through which
air and Oxygen must pass before reaching
the Lungs
--2-It includes the anatomical structures
extending from the nose and mouth
to the larynx and trachea

14. -Successful airway management
requires detailed understanding
of upper and lower airway structure
(ANATOMY) and its functions
(PHYSIOLOGY)
-AIRWAY MANAGEMENT

15. -AIRWAY MANAGEMENT

16. -AIRWAY MANAGEMENT
--REVIEW OF UPPER
AND LOWER
AIRWAY
ANATOMY

17. -AIRWAY MANAGEMENT
UPPER
AND LOWER
AIRWAY
ANATOMY

18. -AIRWAY MANAGEMENT
-UPPER AIRWAY
--This upper airway consists of the following structures above the vocal cords.
IT IS DIVIDED INTO THE FOLLOWING REGIONS
--A- Nose and Oral cavity
--The Nose which is composed of Bone, and Cartilage. It is the primary pathway
for normal breathing. The oral cavity consists of the upper and lower teeth
the tongue and floor of the mouth, the hard palate and the openings of the
major salivary glands.
--The floor of the mouth is supported by the Mylohyoid muscles

19. -AIRWAY MANAGEMENT
--B Pharynx
--In normal size adult males, it is an approximately 13 cm long muscular tube located
behind the oral and nasal cavities. It conducts and carries food to the esophagus and
air to the Larynx, Trachea and Lungs. The pharynx is divided into three sections.
Nasopharynx
--This extends from the back of the internal nasal cavity to the soft palate. It also
contains Adenoids
Oropharynx
--It begins at the soft palate and continues to the level of Hyoid bone. Serves as both
respiratory and food passage. Contains the Tonsils. The tongue is the principal source
of obstruction, usually because of decreased muscle tone related to sedation drugs
such that the tongue falls backward in a supine patient.
Laryngopharynx
--It begins at the level of the Hyoid bone and extends downward where it branches into
two passages. The Larynx at the front which leads to the lungs, the esophagus at
the back which leads to the stomach

20. -AIRWAY MANAGEMENT -NORMAL UPPER AIRWAY

21. -AIRWAY MANAGEMENT -NORMAL UPPER AIRWAY

22. -AIRWAY MANAGEMENT
-NORMAL UPPER AIRWAY
-Innervation and Blood supply
INNERVATION
--A-The motor and most of the sensory supply to the Pharynx is by the
“PHARYNGEAL PLEXUS” and it is formed by the pharyngeal branches
of the VAGUS and GLASSOPHARYNGEAL nerves
BLOOD SUPPLY OF THE PHARYNX
--B-The Pharynx is supplied by the branches of the EXTERNAL CAROTID
(ascending pharyngeal) and SUBCLAVIAN (inferior thyroid) arteries

23. LOWER AIRWAY
-AIRWAY MANAGEMENT
--The lower airway encompasses the structures of the
respiratory system below the Larynx
TRACHEA
--It is a rigid tube approximately from 10 to 15 cm in
length in the middle of the neck, that provides a
passage for air going into the Lungs
BRONCHEAL TREE
--It is a branched Tree – like tube system leading from
the Trachea that conducts air into the Lungs. It is
made up of increasingly smaller tubes terminating
in the Alveoli
LUNGS
--They are paired organs consisting of millions of small
sacs (Alveoli) where gas exchange occurs. The Lungs
occupy most of the space of the thoracic cavity

24. -AIRWAY MANAGEMENT -THE LARYNX

25. -AIRWAY MANAGEMENT
-THE LARYNX
--The Larynx is a 5 to 7 cm long
structure. Its upper boundary
starts at the Tip of the epiglottis
opposite the 3rd to 4rth cervical
vertebra.
--Its lower end is at the lower
border of the cricoid cartilage
--This lies opposite the 6th
cervical vertebra

26. -AIRWAY MANAGEMENT
-LARYNX
--Also called vestibular folds
DNA ventricular folds

27. -AIRWAY MANAGEMENT -LARYNX
-SUPERIOR SURFACE

28. -AIRWAY MANAGEMENT
-THE OPENING BETWEEN THE VOCAL CORDS AT THE UPPER PART OF THE LARYNX
-THE GLOTTIS

29. -AIRWAY MANAGEMENT
-LARYNX
---Enlargement at the top of the Trachea
which houses the vocal cords
--The structure contains muscles, ligaments
and cartilages
--THE EPIGLOTTIS:- is a fibrous leaf like
cartilage that hangs over the laryngeal
inlet and that closes during swallowing
to prevent aspiration of Gastric contents
going into the Trachea

30. -AIRWAY MANAGEMENT
-LARYNX
--The triangular opening between the vocal cords
is called the “GLOTTIC OPENING” and is the entry
point to the Larynx
--It is the “NARROWEST POINT IN ADULT AIRWAYS”
patency of the glottic opening is dependent upon
muscle tone

31. -AIRWAY MANAGEMENT -LARYNX
--THE GLOTTIS IT OPENS FOR INSPIRATION AND CLOSED FOR SWALLOWING

32. -AIRWAY MANAGEMENT -LARYNX
--The vocal cords of the Larynx
as seen by a doctor using a
laryngeal mirror. Note that
the inside of the Trachea can
be seen through the open vocal
cords and the opening to the
esophagus can be seen lying
behind the Larynx

33. -AIRWAY MANAGEMENT
-LARYNX
--NERVE SUPPLY
VAGUS NERVE (10TH nerve)
--It gives three branches
a-Meningeal Branch
b-Auricular Branch
c-Pharyngeal Branch
SUPERIOR LARYNGEAL
a-External Branch and
b-Internal Branch
RECURRENT LARYNGEAL
--It continues in the Thorax and
Abdomen to supply
a-Heart
b-Trachea
c-Lungs and
d-G I Tract (upto Mid - gut)

34. -AIRWAY MANAGEMENT
-LARYNX
-NERVE SUPPLY
-- VAGUS NERVE (10TH nerve) MOTOR TO THE
--It gives three branches AREA
a-Meningeal Branch
b-Auricular Branch
c-Pharyngeal Branch
SUPERIOR LARYNGEAL SUPPLIES
a-External Branch and CRICOTHYROID
b-Internal Branch MUSCLE
RECURRENT LARYNGEAL THIS SUPPLIES ALL
--It continues in the Thorax and OTHER
Abdomen to supply INTRINSIC MUSCLES
a-Heart
b-Trachea
c-Lungs and
d-G I Tract (upto Mid - gut)

35. -- VAGUS NERVE (10TH nerve) MOTOR TO THE (SENSORY)
--It gives three branches AREA
a-Meningeal Branch
b-Auricular Branch
c-Pharyngeal Branch
SUPERIOR LARYNGEAL SUPPLIES (SUPPLIES ABOVE)
a-External Branch and CRICOTHYROID CORDS
b-Internal Branch MUSCLE
RECURRENT LARYNGEAL THIS SUPPLIES ALL (SUPPLIES BELOW)
--It continues in the Thorax and OTHER CORDS
Abdomen to supply INTRINSIC MUSCLES
a-Heart
b-Trachea
c-Lungs and
d-G I Tract (upto Mid - gut)
-AIRWAY MANAGEMENT -LARYNX
-NERVE SUPPLY

36. -AIRWAY MANAGEMENT
-LARYNX
-NERVE SUPPLY
--Unilateral damage of a Recurrent Laryngeal nerve
results in paralysis of paralysis of all the intrinsic
muscles of the larynx except the cricothyroid
muscle which will tend to adduct the vocal cords

37. -AIRWAY MANAGEMENT
-LARYNX
-The Larynx has blood supply by the following arteries
--1-SUPERIOR LARYNGEAL ARTERY
---It arises from the superior thyroid artery which
accompanies the Internal laryngeal nerve
--2-THE INFERIOR LARYNGEAL ARTERY
---This arises from the inferior thyroid artery which
accompanies the Recurrent Laryngeal nerve

38. -AIRWAY MANAGEMENT
--
-PEDIATRIC AIRWAY
-Infant and child considerations

39. --1-More Rostral Larynx
--2-Reletive large tongue
--3-Angled vocal cords
--4-Differently shaped Epiglottis
--5-Funneled shaped Larynx and
its narrowest part of pediatric
airway is cricoid cartilage
Five (5) Differences between
Pediatric and Adult Airway
-AIRWAY MANAGEMENT

40. -AIRWAY
MANAGEMENT
-PEDIATRIC AIRWAY

41. -AIRWAY MANAGEMENT
PEDIATRIC AIRWAY
Pediatric vs Adult upper airway
--1-Larger tongue in comparison
to size of mouth
--2-Floppy epiglottis
--3-Delicate Teeth and Gums
--4-Larynx is more superior
--5-Funnel shaped larynx due to
undeveloped cricoid cartilage
--6-Narrowest point at cricoid ring
before 10 years of age

42. -TRACHEA
a-Infants and children have narrower
tracheas that are obstructed more
easily by swelling
b-Trachea is softer and more flexible
in infants and children
-DIAPHRAGM
a-Chest wall is softer, infants and
children tend to depend more
heavily on the diaphragm for
breathing
-PEDIATRIC AIRWAY
-Pediatric vs Adult upper airway
-AIRWAY MANAGEMENT

43. -PEDIATRIC AIRWAY
-THE CRICOID CARTILAGE
-AIRWAY MANAGEMENT
-Like other cartilage in the
infant and child, the cricoid
cartilage is less developed
and is less rigid. It is the
narrowest part of the
infant’s or child’s airway

44. -AIRWAY MANAGEMENT
-PEDIATRIC AIRWAY
-BLOOD SUPPLY
--The lungs are very vascular organs, meaning they receive
a very large blood supply
--This is because the Pulmonary arteries which supply the
lungs, come directly from the right side of the Heart
--They carry blood which is low in Oxygen and high in
carbon Dioxide into the lungs so that the carbon di oxide
can be blown off, and more oxygen can be absorbed into
the blood stream
--The newly oxygen – rich blood then travels back through
the paired pulmonary veins into the left side of the heart.
From there it is pumped all arround the body to supply
oxygen to cells and organs

45. -AIRWAY MANAGEMENT
-BASIC PHYSIOLOGY

46. -AIRWAY MANAGEMENT
-AIRWAY FUNCTIONS
---Passage that allows the air to move
from atmosphere to alveoli
--Must remain patent (open) at all times
--Anything that blocks airway will cause
decrease in oxygen available to body
--Size of obstruction affects available air
exchange

47. -AIRWAY MANAGEMENT
-RESPIRATORY PHYSIOLOGY
--The physiology of respiration is a complex process
of gas exchange at the cellular level(CO2 and O2)
When air is loaded with oxygen reaches in the
alveoli , cellular respiration occurs.
--Oxygen inhaled into the lungs is moved into the
alveoli through diffusion at the capillary level.
This oxygen diffuses from areas of higher
concentration to areas of low concentration
across the cell wall

48. -AIRWAY MANAGEMENT -RESPIRATORY PHYSIOLOGY

49. -RESPIRATORY PHYSIOLOGY
-AIRWAY MANAGEMENT
--OXYGENATION:-Blood and cells becomes saturated with oxygen
--HYPOXIA:-Inadequate oxygen being delivered to the cells
--SIGNS OF HYPOXIA:-
a-Increased or decreased Heart Rate
b-Altered Mental status (Early sign)
c-Agitation
d-Initial elevation of B.P followed by a decrease in BP
e-Cyanosis (often a late sign)

50. -AIRWAY MANAGEMENT
-ALVEOLAR / CAPILLARY EXCHANGE
--Oxygen – rich air enters the alveoli during
each inspiration
--Oxygen – poor blood in the capillaries passes
into the alveoli
--Oxygen - enters the capillaries as carbon–dioxide
enters the alveoli

51. -AIRWAY MANAGEMENT
-CAPILLARY / CELLULAR EXCHANGE
--Cells give up carbon – dioxide
to the capillaries
Capillaries give up oxygen to the
cells

52. -AIRWAY MANAGEMENT
AIR WAY MANAGEMENT
DOES
NOT MEAN INTUBATION

53. -AIRWAY MANAGEMENT
SO WHAT
DOES
IT MEAN

54. -AIRWAY MANAGEMENT
SO WHAT DOES IT MEAN contd.
--It means to ensure Patency, provide adequate
ventilation and maintain appropriate oxygenation
--Many times we forget Basics the Basics of Life saving
--Merely providing a chin lift or Jaw thrust can open
and or salvage many airways
--The proper use of adjuncts (Oral and Nasal airways)
can covert a difficult – to – ventilate patient into a
stable, well ventilated one

55. -SO WHAT DOES IT MEAN contd
-AIRWAY MANAGEMENT
--The appropriate administration of high
Flow – Oxygen with properly fitted
Masks is enormously beneficial
--We must never forget that airway
management is a collection of Skills and
Techniques not just an attempt to place
a tube or Device into the patient’s mouth
or Trachea

56. -SO WHAT DOES IT MEAN contd.
-AIRWAY MANAGEMENT
REMEMBER THAT
--Oxygenation is more important then Tracheal
intubation
THIS CAN BE DONE BY
--Administrating oxygen via Mask and Bag to
improve oxygenation prior to intubation

57. -AIRWAY MANAGEMENT
-Goals of Airway Management
--1-Relieve airway obstruction (e.g Head tilt –
Jaw Thrust. Finger sweep suctioning)
--2-Pevent Aspiration (e.g Blood, Foreign
Materials, stomach contents > Leads to
pneumonitis >50% mortality rate
--3-Maintain adequate ventilation and Gas
Exchange

58. -AIRWAY MANAGEMENT THE TEN COMMANDEMENTS
OF AIRWAY MANAGEMENT
--1-Oxygenation and ventilation are the top priorities
--2-Airway management does not mean intubation, It
means to ensure patency, Provide adequate
ventilation and maintain appropriate oxygenation.
Many times we forget the basics of airway
management.
--3-Be an Expert at Bag-Valve-Mask ventilation (BVM)
--4-Importance to know about your equipment
a-That daily check sheet is therefore a reason
b-Airway equipment is one of the most important
items you carry. Having backups like (Laryngoscope
blades, Bulbs, Handles, Adjuncts) and the ability to
troubleshoot equipment are also important. Assume
persona responsibility for all airway equipment and
its proper functioning

59. - AIRWAY MANAGEMENT -THE TEN COMMANDEMENTS
OF AIRWAY MANAGEMENT contd.
--5-Know atleast one rescue ventilation Technique and use it
a-Rescue ventilation can best be described as a ventilation attempt to use in the face of a failed airway
(Cant intubate – Cant ventilate) scenario. The most basic rescue Technique is two-persons BVM
ventilation and next, is the use of the COMBITUBE and LMS is recommended. It is easy to use, and
can be inserted quickly and safely, and can accomplish ventilation when previous airway attempts fail.
It allows for blind insertion in the most difficult of patients and situations and provides some protection
against Aspiration and high airway pressures
--6-Develop a personal airway algorithm
a-Each provider should have an algorithm specific to their skill level and approved scope of practice.
Not all patients and situations you encounter are going to be the same. Having only one or two airway
skills in your repertoire can lead to be a potentially dangerous approach to airway management.
Every ones algorithm should begin with the Basics. For example start with BVM ventilation, and
advance to ET intubation, then place a COMITUBE and finally perform a surgical “cricothyrotomy”
This plan should be calmly practiced and Mastered
--7-Don’t let your EGO get in the way
a-This can be dangerous for your patient, your partner or colleagues, and your carrier. Remember
your Goal is excellent patient’s care and a positive outcome, not skill accumulation or personal
success. Don’t ever forget to ask for assistance when you need it

60. -AIRWAY MANAGEMENT
THE TEN COMMANDEMENTS
OF AIRWAY MANAGEMENT
--8-Invest time in learning airway skills
a-Regularly devote training and practice time to airway management. Try not to limit yourself to
manikin airway trainers if possible. Work on gaining access to the simulator Lab, operating room
or emergency department. Also read about the latest Techniques and advances in airway
management. Attend conferences and airway obstacles courses for more hand on training
--9-Use CAPNOGRAPH and tidal CO2 detector and / or esophageal detector device to assist you in
confirming every intubation.
--10-When second count, don’t count on seconds
a-Each airway maneuver or intubation attempt should be your best effort. Often our best chance
at getting a decent airway is the first attempt. Maximize your chances by leaving nothing to
chance. Being prepared often means the difference between SUCCESS and FAILURE.

61. -AIRWAY MANAGEMENT
-PROCEDURE OF AIRWAY MANAGEMENT
--Airway can be managed with (Advanced)
or without
Tracheal Intubation (Basic)

62. -AIRWAY MANAGEMENT
BASIC AIRWAY MANEUVRES
ALWAYS REMEMBER THE BASICS
--These skills should be used
prior to initiating any advanced
airway Technique
a-Head Tilt and Chin Lift
b-Jaw thrust
c-Modified Jaw thrust (For trauma patients)
d-Sellick’s maneuver

63. -AIRWAY MANAGEMENT
BASIC AIRWAY MANEUVRES
ALWAYS REMEMBER THE BASICS
USE HEAD TILT
AND CHIN LIFT
OR JAW THRUST
TO OPEN THE AIRWAY

64. -AIRWAY MANAGEMENT
TECHNIQUES OF BASIC
AIRWAY MANAGEMENT
NON INVASIVE
--1-Head Positioning
--2-Removal of Foreign body
--3-Suctioning
--4-Mask ventilation

65. -AIRWAY MANAGEMENT
-OPENING and HEAD POSITIONING
C-COMBINED
REMEMBER:-
Cervical spine stabilization
A-JAW THRUST
B-HEAD TILT CHIN LIFT

66. -AIRWAY MANAGEMENT
AIRWAY MANAGEMENT
--A-Head Tilt Chin Lift
--B-Jaw Thrust
--c-Trauma
-Manual Methods

67. -AIRWAY MANAGEMENT
-HEAD TILT / CHIN LIFT

68. -AIRWAY MANAGEMENT
-HEAD – TILT/CHIN - LIFT
TECHNIQUE
--1-Place one hand on patient’s Forehead
--2-Apply firm backward pressure with
--3-Palm causing Head to tilt backwards
--4-Place fingers of the other hand under
the bony part of the patient’s lower
jaw near the chin
--5-Lift the Jaw upward to bring the chin
forward

69. -AIRWAY MANAGEMENT
HEAD – TILT/CHIN - LIFT
--1-Loss of consciousness is often
accompanied by loss of
submandibular muscle tone.
--2-Occlusion of the airway by
tongue can be relieved by a
Head Tilt Chin Lift Technique
(If there is no evidence of
cervical spine injury)

70. -AIRWAY MANAGEMENT -HEAD – TILT/CHIN - LIFT
--Falling of tongue backward
during loss of consciousness
--This is the most common
cause of upper airway
obstruction
--This can easily be relieved by
a Head Tilt/Chin lift or Jaw
Thrust maneuvers

71. -AIRWAY MANAGEMENT
-AIRWAY ADJUNCTS
--OROPHARYNGEAL AIRWAY
--NASOPHARYNGEAL AIRWAY

72. -AIRWAY MANAGEMENT
-AIRWAY ADJUNCTS
-NASOPHARYNGEAL AIRWAY
-OROPHARYNGEAL AIRWAY

73. -AIRWAY MANAGEMENT
-AIRWAY ADJUNCTS
OROPHARYGEAL AIRWAY (OP)
--1-This helps prevent tongue from obstructing posterior pharynx
--2-Potential use in unconscious patients
--3-Cannot use in patients with intact Gag reflex
--4-SIZING:-Measure from corner of mouth to angle of Jaw
--5-PLACEMENT:-Direct method verses Rotation method

74. -AIRWAY MANAGEMENT
AIRWAY ADJUNCTS
-NASOPHARYNGEAL AIRWAY
--1-Unconscious or depressed mental status
--2-SIZING:-Measures from the Tip of the nares
to the tragus of the ear
CONTRAINDICATIONS
--3-Basilar skull fracture, mid face fractures
bleeding disorders
--4-Relieve contraindications child < 1 year old

75. -AIRWAY MANAGEMENT
-OROPHARYNGEAL AIRWAYS
-FEATURES:-
a-Single use
b-Rounded Edges
c-Bite Block
d-Colour coding
e-Airway path in center

76. -AIRWAY MANAGEMENT
-HOW DO YOU
SIZE
ORAL AIRWAYS

77. -AIRWAY MANAGEMENT
-SIZING THE ORO-PHARYNGEAL-AIRWAY
--The correct size of ORAL airway will
vary for each patient according to his
Make, Built, and Anatomy
--To get the proper size of oro-pharyngeal
-airway it is measured against the distance
from the corner of the patient’s mouth
to the patient’s ear lobe

78. -AIRWAY MANAGEMENT
-CORRECT SIZE
--It is measured
against the
distance from
the corner of
the patient’s
mouth to the
patient’s earlobe

79. -AIRWAY MANAGEMENT
-INCORRECT SIZE
--If an airway
is too
small, it
may obstruct
the airway

80. -AIRWAY MANAGEMENT
-INCORRECT SIZE
--If an airway
is too
Large, it
may obstruct
the airway

81. -AIRWAY MANAGEMENT
INCORRECT INSERTION OF AN
OROPHARYNGEAL AIRWAY
--It can displace the tongue
into the Hypopharynx
causing the airway
obstruction

82. -AIRWAY MANAGEMENT
-IMPROPER PLACEMENT OF
OROPHARYNGEAL AIRWAY

83. -AIRWAY MANAGEMENT INSERTING OF AN
OROPHARYNGEAL AIRWAY
---It is the
responsibility of
every provider
regardless of
certification
level
to manage a
patient’s airway
in the most
effective way
possible

84. -AIRWAY MANAGEMENT
-INSERT THE OROPHARYNGEAL AIRWAY
-PLACE THE CASUALTY ON HIS BACK
--Place your thumb and index finger of one hand on the
casualty's upper and lower teeth near a corner of the
mouth so the thumb and finger will cross when the
casualty’s mouth is opened
--Push your thumb and index finger against the casualty’s
upper and lower teeth in a scissors like motion until
his teeth separate and his mouth opens
--If the teeth do not separate, wedge your index finger
behind the casualty’s back Molars and force the teeth
a part

85. -AIRWAY MANAGEMENT
HOW TO INSERT THE
OROPHARYNGEAL AIRWAY
--Place the Tip end of the airway into the casualty’s mouth.
Make sure the Tip is on top of the tongue.
Point the tip of the airway up towards the roof of the
casualty’s mouth
--Slide the airway along the roof of the casualty’s mouth
following the curvature of the tongue.
--When the Tip of airway reaches the back of the tongue
passed the soft palate, rotate the airway 180 degrees so
the Tip of the airway points towards the casualty’s throat

86. - AIRWAY MANAGEMENT
HOW TO INSERT THE
OROPHARYNGEAL AIRWAY
--Advance the airway until the flange
rests against the casualty’s lips
--The airway should now be positioned
so the tongue is held in place and
will not slide to the back of the
casualty’s throat

87. -AIRWAY MANAGEMENT
-INSERTION OF THE OROPHARYNGEAL AIRWAY
---Using a head-Tilt=chin-lift, a modified
Jaw-Thrust, or by grasping the tongue
and Jaw by placing your thumb in the
patient’s mouth, move the tongue
forward

88. -AIRWAY MANAGEMENT
-INSERTION OF THE
OROPHARYNGEAL AIRWAY
--Position the oropharyngeal
airway as shown with the
Tip in the patient’s mouth
and slowly insert the
Oropharyngeal airway

89. -AIRWAY
MANAGEMENT
-INSERTION OF THE
OROPHARYNGEAL AIRWAY
--At the point resistance
is met, but insertion
should be continued
while simultaneously
rotating the
oropharyngeal airway
by 180 degrees

90. AIRWAY
MANAGEMENT
-INSERTION OF THE
OROPHARYNGEAL AIRWAY
--Advance the
oropharyngeal airway until
the flange is resting on or
just above
The patient’s teeth

91. -AIRWAY MANAGEMENT
-INSERTION OF THE
OROPHARYNGEAL
AIRWAY
--Blindly inserting the oral
airway upside down and
turning it 180 degrees
when once it is in the
mouth may push the
tongue against the
posterior pharynx which
helps to open airway

92. -AIRWAY MANAGEMENT
MONITOR A CASUALTY
WITH AN OROPHARYNGEAL
AIRWAY IN PLACE
--Check the casualty’s respirations
to make sure he is still breathing
adequately and the oropharyngeal
airway is not blocking his airway
Re adjust the position of the
oropharyngeal Airway if needed

93. -AIRWAY MANAGEMENT
--1-The position of the airway in the patient’s
Mouth and breath sounds should be
assessed Frequently
--2-The oral cavity should be suctioned as
needed
--3-Mouth care should be done every two to
four hours and as needed
--4-Mouth care can be done with a moistened
swab
-SOME TIPS TO CARE FOR A PATIENT
WITH AN OROPHARYNGEAL AIRWAY

94. -AIRWAY MANAGEMENT
SOME TIPS TO CARE
FOR A PATIENT WITH AN
OROPHARYNGEAL AIRWAY
--1-If the airway is coated with secretions, it
can be removed and insert a dean airway
--2-If the patient has the oropharyngeal airway
as a long term measure, the airway should be
cleaned and replaced at least once every eight
hours

95. -AIRWAY MANAGEMENT
-OROPHARYNGEAL AIRWAY
-GAG REFLEX

96. -AIRWAY MANAGEMENT -OROPHARYNGEAL AIRWAY
-LOOK FOR PROPER SIZE -PROPER POSITION OF AIRWAY

97. -AIRWAY MANAGEMENT
QUESTION
SHOULD YOU TIE OR TAPE THE AIRWAY IN PLACE
RESPONSE
NO
QUESTION
WHAT SHOULD YOU DO IF THE CASUALTY (PATIENT)
BEGINS TO REGAIN CONSCIOUNESS
RESPONSE
REMOVE THE AIRWAY
-QUESTIONS

98. -AIRWAY MANAGEMENT
2-NASOPHARYNGEAL AIRWAY
--1-Soft plastic or rubber tube that is designed to pass just
inferior to the base of the tongue
--2-Passed through one of the Nares and can be used in
patients with an intact Gag reflex
--3-CONTRAINDICATED in cases of suspected or possible
Basilar skull fracture
--4-Sizes range from 17 to 26 cm in length and 6 to 9 mm
in internal diameter
--5-Measured from the Tip of the nose to the corner of
the patient’s ear

99. -AIRWAY MANAGEMENT
-NASAL AIRWAY contd.
--6-The nasal airway is lubricated with a
water soluble lubricant
--7-The beveled Tip is inserted directed
towards the septum with the airway
directed perpendicular to the face
--8-If resistance is met, rotating the
airway may help or the other Nare
may used

100. -AIRWAY MANAGEMENT
NASOPHARYNGEAL AIRWAY contd.
--IT IS CONTRAINDICATED
IN PATIENTS WITH
FRACTURE
OF THE BASE OF
SKULL

101. -AIRWAY MANAGEMENT
--NASOPHARYNGEAL AIRWAY

102. -AIRWAY MANAGEMENT
NASOPHARYNGEAL AIRWAY contd.
--The length is 2 to 4 cm longer then oral airway
--Used to relieve upper airway obstruction caused
by tongue or soft palate falling against posterior
wall of the pharynx
--suction via this airway is less traumatic then oral
airway
--It is better tolerated then oral airway. Especially in
awake or lightly anesthetized patients
--After it is lubricated it can be gently inserted down
at an angle
--To avoid traumatizing the turbinate or the roof
of the nose

103. -AIRWAY MANAGEMENT
-NASAL AIRWAYS
--Patients needing Nasal airway
a-Unresponsive patients who are snoring
b-Unresponsive patients with Gag reflex

104. -AIRWAY MANAGEMENT
-NASAL AIRWAYS contd.
--It should be changed in position in every
24 hours between right and left Nares to
minimize complications
It should not be used in
a-Anticoagulant patients
b-Children with prominent Adenoids
Absolute contraindications
a-Fractures of the Base of the skull
b-Other conditions like:-
1-Sinusitis
2-Otitis Media
3-Nasal necrosis
4-possible complications by its use

105. -SIZING OF THE
NASOPHARYNGEAL
AIRWAY
--The correct size will vary with each patient
To size the Nasopharyngeal airway it is
measured against the distance from the
patient’s nose to the patient's ear lobe
-AIRWAY MANAGEMENTd

106. -AIRWAY MANAGEMENTd
-INCORRECT SIZE
-CORRECT SIZE

107. -AIRWAY
MANAGEMENT
-PROCEDURE OF
-INSERTION OF AN
NASOPHARYNGEAL
AIRWAY
--First check the nostril for signs of
fracture or obstruction then apply
generous amounts of water-based
lubricant to the NPA taking care
not to fill the Tip with the lubricant

108. -AIRWAY
MANAGEMENT
--PROCEDURE OF
-INSERTION OF AN
NASOPHARYNGEAL
AIRWAY
--Orient the bevel end so
that it will pass Along
the inside of the minimal
effort and insert the NPA
until the flange(The large
end of the tube) is seated
on the patient’s nose.
AS SHOWN IN THE
PICTURE

109. -AIRWAY
MANAGEMENT
-- PROCEDURE OF
-INSERTION OF AN
NASOPHARYNGEAL
AIRWAY
--The NPA’s can be inserted to provide even better
ventilation. Placing the second NPA is similar in
Fashion with one difference, The bevel of the
second NPA must be oriented to the nasal
septum a was the first but the curvature of
the NPA itself indicates that while being
inserted, it must be turned 180 degrees when
about half way into the nasal cavity

110. -AIRWAY MANAGEMENTd
-SPECIAL CONSIDERATIONS
OF INSERTION OF AN
NASOPHARYNGEAL
AIRWAY
---Another acceptable sizing technique is to match
the diameter of the NPA to that of the patient’s
litter finger
--If significant resistance is felt upon insertion of
the NPA , remove it and attempt placement in
the opposite nostril
--Be prepared for Bleeding that may occur with the
placement of the NPA.
--ALWAYS make efforts to be prepared with suction
devices at the ready with all airway procedures
in the event the patient should vomit

111. -AIRWAY MANAGEMENTd
--Using an airway that is too long; This may
cause the Tip to enter the esophagus
--Injuring the Nasal mucosa causing bleeding.
this can lead to ASPIRATION of blood or
clots
--If Nasal airway doesn’t have flange at the
nasal end he can lose airway in nose while
passing
-POTENTIAL HAZARDS INVOLVED IN
THE USE OF
NASO-PHARYNGEAL-AIRWAYS

112. -AIRWAY MANAGEMENTd
QUESTIONS
FOR EXERCISE
---Q-1 An NPA shouldn’t be used if ---------------has been
found in the patient’s Nose
a-Blood
b-Vomitus
c-Cerebrospinal Fluid
d-Soft tissue damage

113. -AIRWAY MANAGEMENTd
-QUESTIONS
FOR EXERCISE
---Q-2- As you are inserting an oropharyngeal
airway, your patient begins to Gag you should
--1-Continue placing the airway, as the Gagging will
cease when it is completely inserted
--2-Roll the patient on his side and continue inserting
the airway
--3-Apply “cricoid pressure” to prevent vomiting immediately
--4-Remove the airway and prepare to make suction

114. -AIRWAY MANAGEMENTd
-QUESTIONS
FOR EXERCISE
--1-Nasopharyngeal airway
--2-Oropharyngeal airway
--3-Pharyngeal lumen airway
--4-Nasal canula
--Q-3-Which airway adjunct can be used
if the patient has a Gag reflex

115. -AIRWAY MANAGEMENTd
-QUESTIONS
FOR EXERCISE
--Q-4-The preferred method of inserting an oropharyngeal airway in a child is
--1-By using a tongue depressor to press the tongue down while
inserting the airway
--2-By inserting the airway so that the Tip is pointing towards
the roof of the mouth, and rotating it 180 degrees as you
insert it
--3-By inserting the airway with the Tip towards the side of the
patient’s mouth, and Rotating it 90 degrees as you insert it.
--4-None of the above. Oropharyngeal airways are not
recommended for children

116. -AIRWAY MANAGEMENTd
-QUESTIONS
FOR EXERCISE
-Q-5-Which of the statements is true regarding the oropharyngeal airway
--1-The oral airway may be used in any conscious patient
who needs airway control
--2-Even with the airway inserted it is necessary to
maintain the position of the head
--3-Measure the oral airway by comparing the
patient’s little finger
--4-The preferred method of insertion in an infant or child
is upside-down first

117. -AIRWAY MANAGEMENTd
QUESTIONS
FOR EXERCISE
--Q-6-Why is proper size is important when using an OPA or NPA
--1-Too large size may block the airway
--2-Too large airway may damage the tissues
--3-Too small size may not adequately
control airway
--4-All of the above

118. -AIRWAY MANAGEMENTd
-QUESTIONS
FOR EXERCISE
--Q-7-You are considering use of an oropharyngeal airway
(OPA) you know that all of the following are true
EXCEPT
--1-A too large OPA may obstruct the larynx
--2-A too small OPA may obstruct the airway
by pushing the tongue into the throat
--3-You should insert the OPA so that it curves
Upward and then rotate it 180 degrees
to match the curve of the tongue and
throat
--4-OPA’s are safe to use in all patients

119. -AIRWAY MANAGEMENTd
BAG-VALVE-MASK
VENTILATION
(BVM)

120. -AIRWAY MANAGEMENTd
BE AN EXPERT AT
BAG-VALVE-MASK
(BVM)
VENTILATION

121. -AIRWAY MANAGEMENTd
BAG-VALVE-MASK
(BVM)
VENTILATION
INDICATIONS
--The bag valve mask is a device used to
deliver positive pressure ventilation
to patients
a-Who are breathing in efficiently
and ineffectively
b-OR not breathing at all

122. -AIRWAY MANAGEMENTd
-- BAG-VALVE-MASK
(BVM)
VENTILATION
contd.
--1-Bag-Mask ventilation is a basic but critical
airway management skill
--2-It enables clinicians to provide adequate
ventilation for patients requiring airway
support and allows enough time to establish
a more controlled approach to airway
management.
--3-Because the technique can be difficult to
perform correctly, clinicians performing the
procedure should continually practice and
monitor their technique

123. -AIRWAY MANAGEMENTd
BAG-VALVE-MASK
Composition of BVM Ventilation
a-Self inflating Bag
b-One-way valve
c-Face Mask
d-Oxygen Reservoir
-Must be connected to oxygen to perform most effectively

124. -AIRWAY MANAGEMENTd
BAG-VALVE-MASK
--1-By adding oxygen and reservoir close to 100% oxygen
can be delivered to the patient
--2-When using a BVM an OPA or NPA should be used
if possible
--3-Volume of approximately 1,600 millimeters
--4-Provide less volume than Mouth-to-mask
--5-Single Rescuer may have trouble maintaining seal
--6-Two rescuers are more effective
--7-Available in Infants, Childs, and Adult sizes

125. -AIRWAY MANAGEMENTd
BAG-VALVE-MASK

126. -AIRWAY MANAGEMENTd
-Bag and Mask ventilation is an important
clinical skill to Master
--1-In most Resuscitation settings a
self-re-inflating bag
--2-With non-rebreathing valves
(such as that shown) is used to
provide positive pressure
ventilation, usually using 100%
oxygen
--3-This bag fills spontaneously
after being squeezed and can
be used even when oxygen is
unavailable

127. -AIRWAY MANAGEMENTd
-STRATEGIES
FOR
SUCCESSFUL
BVM
VENTILATION

128. -AIRWAY MANAGEMENTd
-APPLYING THE BVM
--The Mask of the BVM should be placed
over the patient’s Nose and Mouth to
ensure an adequate seal between the
patient’s Face and the Mask itself.
OFA / NPA can be used in conjunction
with the BMV to ensure adequate
passage for each ventilation

129. -AIRWAY MANAGEMENT
BASIC SKILL OF
BVM
Paying attention to
the Basics of this skill
will make it maximally
effective

130. -AIRWAY MANAGEMENT
-SINGLE PERSON BVM

131. -AIRWAY MANAGEMENT TWO PERSON (BVM)

132. -AIRWAY MANAGEMENT
BAG-MASK-VENTILATION
--All healthcare providers
should be familiar
with the use of the
Bag Mask device for
support of
oxygenation and
ventilation

133. AIRWAY
MANAGEMENT
BAG-MASK
VENTILATION
--With the two-Provider technique
one person should hold the Mask
with both hands, while the other
bags the patient
-An alternative method for the Mask
holder to apply pressure to the
Mask while using four fingers to
apply Jaw lift

134. -AIRWAY MANAGEMENT
SUCCESSFUL BAG-MASK
VENTILATION
DEPENDS ON FOLLOWING
THREE THINGS
--PATIENT’S AIRWAY:-
--Airway patency can be established using basic airway
maneuvers
--ADEQUATE MASK SEAL:-
--In order to secure a good seal, the mask must be placed
and held correctly
--PROPER VENTILATION:-
--i.e proper volume rate

135. -AIRWAY MANAGEMENT
IN ORDER TO SECURE A GOOD SEAL, THE MASK
MUST BE PLACED AND HELD CORRECTLY
--1-EXCESSIVE TIDAL VOLUME:-
--A volume just large enough to cause chest rise(no more than 8 to 10 CC / Kg)
should be used. During cardio-pulmonary resuscitation(CPR) even smaller
tidal volumes are adequate (5 to 6 CC / Kg) due to the reduced cardiac
output of such patients
--2-FORCING AIR TOO QUICKLY:-
--The bag should not be squeezed explosively. It should be squeezed explosively
It should be squeezed steadily over approximately one full second
--3-VENTILATION TOO RAPIDLY:-
--The ventilatory rate should not exceed 10 to 12 breaths per minute

136. -AIRWAY MANAGEMENT
VENTILATION TECHNIQUES
(BVM ISSUES)
--Single rescuer may have difficulty in
maintaining air tight seal
--Two rescuers using device are more effective
--Position yourself at top of patient’s head for best
performance
--Oral or Nasal airway should be inserted

137. -AIRWAY MANAGEMENT
VENTILATION TECHNIQUES
--Open airway, insert oral or nasal airway
--Position thumbs over top half of mask, index and middle fingers
over the bottom half
--Place apex of mask over bridge of Nose, lower mask over mouth
and upper chin
--Use ring and little fingers to bring Jaw upto mask
--Have an assistant to squeeze the bag with two hands until
chest rises
--Ventilate every 5 seconds for Adults, every 3 seconds for infants and children

138. -AIRWAY MANAGEMENT
BAG-MASK VENTILATION
Two persons fitting technique
is more effective
--ONE PERSON SECURES
THE MASK TO THE FACE
WHILE AN ASSISTANT
DELIVERS BREATH

139. -AIRWAY MANAGEMENT Two hands method with one rescuer using two
hands to hold the mask in place while another
rescuer applies PPV with the BMV
--The rescuers places his / her thumb and index
finger to hold the mask while the Middle,
Ring and pinky fingers are used to grasp the
soft tissue under the patient’s Jaw. Forming
a seal as the patient’s face is pulled up.

140. -AIRWAY MANAGEMENT
-QUESTIONS
FOR EXERCISE
--Q-8- When using a BAG-VALVE-MASK to ventilate a non
breathing patient
--1-Position yourself to the side of the patient’s head
--2-Use your Ring and little finger to bring the patient’s
Jaw upto the mask
--3-It is not necessary to use an airway adjunct
--4-Give one ventilation every 12 seconds