This document discusses airway evaluation, management of intubation, and complications. It outlines indications for intubation including resuscitation, prevention of lung soiling, and respiratory failure. Successful intubation requires a normal anatomy of the mandible, temporomandibular joint, atlanto-occipital joint, and cervical spine. Proper equipment and gadgets are also needed. Tests like the Mallampatti and Wilson scores can predict difficulty, and a history of previous issues is also informative. Securing the airway awake is recommended for expected difficult airways, and maintenance of oxygenation should be the primary aim with backup plans in place for unexpected difficulties.

1. Airway Evaluation and Management

2. Indications of intubation Resuscitation (CPR) Prevention of lung soiling Positive pressure ventilation (GA) Pulmonary toilet Patent airway (coma or near coma) Respiratory failure(CO2 retention )

3. Requirement of successful intbatin 1-Normal roomy mandible 2-Normal T-M, A-O , and C-spine

4. Requirements of successful intubation 3-Alignment of 3 axes or Assuming sniffing position -Any anomaly in these 3 joints A-O, T-M or C-spine can result In difficult intubation

5. Requirement of successful intubation Proper equipment -Bag and mask,oxygen source -Airways oro and nasopharyngeal -Laryngosopes different blades -ETT different sizes -suction on

6. Airway gadgets

7. Management I-History: previous history of difficulty is the best predictor Inquire about:-Nature of difficulty -No of trials -Ability to ventilate bet trials -Maneuver used -Complications II-Snoring and sleep apnea( prdictors of DMV)

8. Examination -Look for any obvious anomaly Morbid obesity(BMI) Skull Face Jaw Mouth,teeth Neck

9. Examination I-The 3 joints movements A-O joint(15-20 degrees) Presence of a gap bet the Occiput and C1 is essential The cervical spine(range>90) T.M joint:-interdental gap(3 fingers) -subluxation (1 finger)

10. Examination II-Measurements of the mandible -Thyro-mental distance (head extended) Normally 6.5 cm Less than 6 cm=expect difficulty

11. Tests to predict difficulty Mallampatti test: Based on the hypothesis That when the base of the Tongue is disproportionally Large it will overshadow the larynx

12. -Simple easy test,correlates with what is seen during laryngoscopy or Cormack-Lehene grades ,but 1-moderate sensitivity and specificity(12% false +ve) 2-Inter observer variation 3-Phonation increases false negative view

13. II-Wilson test -Consists of 5 easily assessed factors Body wight(n=0 ,>90=1,>110=2) Head and neck movement Jaw movement Receding jaw Buck teeth Each factor assigned as o ,1 ,2 max is 10

14. Difficult airway Expected from history,examination Secure airway while awake under LA Unexpected different options Priority for maintenance of patent airway and oxygenation

15. Airway gadgets

17. Needle cricothyroidotomy

18. Confirm tube position Direct visualization of ETT between cords Bronchoscopy ;carina seen Continuous trace of capnography 3 point auscultation Esophageal detector device Other as bilateral chest movement,mist in the tube,CXR

19. Rapid sequence induction Indications Technique: -Preoxygenation -IV induction with sux -Cricoid pressure -Intubate, inflate the cuff ,confirm position -Release cricoid and fix the tube

20. Complications of intubation 1-Inadequate ventilation 2-Esophageal intubation 3-Airway obstruction 4-Bronchospasm 5-Aspiration 6- Trauma 7-Stress response

21. Recommendations Adequate airway assessment to pick up expected D.A to be secured awake Difficult intubation cart always ready Pre oxygenation as a routine Maintenance of oxygenation not the intubation should be your aim Use the technique you are familiar with Always have plan B,C,D in unexpected D.A