This document discusses airway management techniques. It outlines the airway hierarchy from least to most invasive: oxygen delivery devices like nasal cannulas and masks, non-invasive airways like oropharyngeal and nasopharyngeal airways, and bag-mask ventilation. More invasive devices include the laryngeal mask airway and endotracheal tube. It describes how to use and place these devices, as well as their complications. Endotracheal intubation, though more invasive, is generally considered the gold standard for airway control.

1. AIRWAY
MANAGEMENT

2. Learning and SkillsObjectives
• Describe the “airway hierarchy”
• Be able to use airway devices
• Understand the complications of these airway
devices

3. “Airway hierarchy”
• Laryngeal mask airway(LMA)
• Endotracheal tube (ETT)
– Oxygen delivering devices:
• Nasal cannula
• Face mask
• Mask with reservoir
– Non-invasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:

4. “Airway hierarchy”
– Oxygen delivering devices:
• Nasal cannula
• Face mask
• Mask with reservoir
– Non-invasive airwaydevices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airwaydevices:
• Laryngeal mask airway(LMA)
• Endotracheal tube (ETT)

5. Oxygen Delivering Devices
In breathing patients who can protect his airway,
conscious or unconscious
Nasal cannula Simple facemask
Venturimask Mask with O2 reservoir

6. “Airway hierarchy”
– Oxygen deliveringdevices:
• Nasal cannulae
• Face masks
– Non-invasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airwaydevices:
• Laryngeal mask airway(LMA)
• Endotracheal tube(ETT)

7. Oropharyngeal or
Nasopharyngeal Airway
Only in unconscious patient to prevent the
tongue from falling back
Oropharyngealairway Nasopharyngeal airway

8. Oropharyngeal and
Nasopharyngeal Airway
in Correct Position
Oropharyngeal airwayin
place in themouth
Nasopharyngeal airwayin
place in thenose

9. “Airway hierarchy”
– Oxygen deliveringdevices:
• Nasal cannulae
• Face masks
– Non-invasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airwaydevices:
• Laryngeal mask airway(LMA)
• Endotracheal tube(ETT)

10. Pocket-mask and Bag-mask
1-way valve
Toventilate patients non-invasively

11. Bag-mask Ventilation
1-hand technique forBVM 2-hand technique forBVM

12. “Airway hierarchy”
– Oxygen deliveringdevices:
• Nasal cannula
• Face mask
– Noninvasive airwaydevices:
• Oropharyngeal airway
• Nasopharyngealairway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:
• Laryngeal mask airway(LMA)
• Endotracheal tube(ETT)

13. Laryngeal Mask Airway(LMA)
The LMA - a SUPRAGLOTTIC airway that
consists of a tube with a cuffed mask-like
projection at distal end

14. LMA - Indications
• When mask ventilation fails to achieve adequate
oxygenation
• As an adjunct to airway management by
personnel not skilled in tracheal intubation
• As an adjunct to airway management by
personnel skilled in tracheal intubation when
endotracheal intubation is difficult or not
successful

15. Insertion: Preparation
• Choose the appropriate size
• Recommended size guidelines:
– Size 1:
– Size 1.5:
– Size 2:
– Size 2.5:
– Size 3:
– Size 4:
– Size 5:
< 5 kg
5 - 10 kg
10 - 20 kg
20 - 30 kg
30 - 50 kg
50 – 70 kg
>70 kg

16. LMA in place in the Mouth

17. Complications of LMA
 Sore throat
 Dysphagia
 Dryness of the throat and/or mucosa
 Tongue cyanosis
 Vocal cord paralysis
 Major: Aspiration

18. “Airway hierarchy”
– Oxygen deliveringdevices:
• Nasal cannula
• Face mask
– Noninvasive airwaydevices:
• Oropharyngeal airway
• Nasopharyngealairway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:
• Laryngeal mask airway(LMA)
• Endotracheal tube (ETT)

19. CONTROL OF THE
AIRWAY WITH
ENDOTRACHEAL TUBE
IS USUALLY REGARDED AS THE
“GOLD STANDARD”
limited to trained and skilled personnel

20. Endotracheal Intubation
Weigh benefit of intubation VS adverse effect of
interrupting chest compressions during
intubation
Intubation should be done by most experienced
person
Do not take longer than 30 seconds per attempt

21. Curved Blade Attachedto
Laryngoscope Handle

22. Aligning Axes of Upper Airway
A
Extend-the-head-on-neck (“look up”): aligns axis A relative to B
Flex-the-neck-on-shoulders (“look down”): aligns axis B relative to C
C
B
A
B
C
Trachea
Pharynx
Mouth

23. Cricoid Pressure vs
BURP manoeuvre
Thyroid
Cartilage
Cricoid

24. Visualization of Vocal Cords
Glottic
opening
Arytenoid
cartilage
T
ongue
Epiglottis
Vallecula
Vocal
cord
Anatomy

25. Endotracheal Intubation
Complications
• Hypoxia – the act of intubation is an hypoxic
event
• Trauma—teeth, lips, tongue, mucosa, vocal
cords, trachea
• Vomiting and aspiration
• Hypertension/hypotension and arrhythmias

26. Confirmation of advanced
airway placement
• Colour
• Visible chest rise
• Vapour in ETT
• 5 points auscultation
• Capnography / CO2 detector devices

27. THANK YOU
NATIONAL COMMITTEE ON RESUSCITATION TRAINING
SUBCOMMITEE FOR ADVANCED LIFE SUPPORT
 Dr Tan Cheng Cheng
 Dr Luah Lean Wah
 Dr Ismail Tan bin Mohd Ali Tan
 Dr Wan Nasrudin bin Wan Ismail
 Dr Chong Yoon Sin
 Dr Priya Gill
 Dr Ridzuan bin Dato’ Mohd Isa
 Dr Thohiroh binti Abdul Razak
 Dr Adi bin Osman