This document discusses the importance of airway management. It begins by defining the airway and its functions. Proper airway assessment, planning, and management are emphasized to ensure adequate oxygenation, ventilation and airway protection. The document covers airway anatomy, various assessment techniques including inspection of the mouth and neck, and listening to breathing sounds. Airway devices like face masks, laryngeal mask airways and endotracheal tubes are presented as options to maintain the airway. The importance of having a thorough airway plan that accounts for skills, resources and contingencies is stressed. Sample plans for elective and emergency scenarios are provided. The talk concludes by highlighting the need to plan first to ensure successful airway

1. The airway
Ed Burdett
23 July 2011

2. What is an airway?
A conduit between the lungs and
the outside world

3. The airway always comes first
A
B
C
D

4. Airway management:
• Oxygenation
• Ventilation
• Airway protection

5. Airway plan!
Airway assessment
Need for airway
protection
My skills and
resources
What if it goes
wrong?!

6. This talk…
• Anatomy
• Assessment
• Managing the airway
• Indications for interventions
• Scenarios

7. Anatomy

11. Airway anatomy is important

12. Airway assessment
• Look
• Listen
• Feel
• (Tests)
Pragmatic
approach: what
needs to be done to
the airway?

13. Airway plan!
Airway
assessment
Need for airway
protection
My skills and
resources
What if it goes
wrong?!

14. Airway assessment - look
• Will a mask create a good seal?
• Appearance/teeth/beard
• Mouth opening - Mallampatti
• Thyromental distance and neck movement

15. Look
Mallampatti

16. Listen
• Talking
• Breathing
– Stridor - extrathoracic
– Respiratory distress
– Wheeze - intrathoracic

17. Feel
• Radiotherapy
• Burns
• Back of neck

18. Tests

19. Abnormal anatomy

20. Abnormal anatomy

21. Maintaining the airway
Goal: adequate oxygenation, ventilation, protection

22. Airway plan!
Airway assessment
Need for
airway
protection
My skills and
resources
What if it goes
wrong?!

23. (How) do you need to manage the
airway?

24. Chin lift, jaw thrust

25. Airway adjuncts

26. Measuring
Adult male
Adult female

27. Other ways to maintain the airway
LMA
• Easy
• Non-traumatic
• Effective
• Stops airway soiling
but not aspiration

28. Laryngeal mask insertion

30. The secure airway is a cuffed tube in the
trachea

33. Direct laryngsocopy

34. Macintosh >95% success

35. ?

36. “Rapid sequence induction”
• Intubation with maximal airway protection
• For those at risk of aspiration
– Full stomach
– Acute abdomen
– Systemically unwell
– Preoxygentation/quick onset drugs/cricoid pressure

37. Indications for airway management
• Oxygenation
• Ventilation
• Airway protection

38. Airway plan!
Airway assessment
Need for airway
protection
My skills and
resources
What if it goes
wrong?!

40. Airway plan!
Airway assessment
Need for airway
protection
My skills and
resources
What if it goes
wrong?!

41. Making an airway plan
Context
Elective or emergency
Theatre/A&E/ICU
Patient status/surgical plan
Airway assessment
How easy is my plan going to be?
What to do if it goes wrong?

42. Example airway plan: elective
hernia repair, healthy 30 yo.
• Plan A – Elective induction, Laryngeal mask
• Plan B – Face mask ventilation +/- Guedel
• Plan C – Call for senior help, wake up

43. Case study 1
• You’re asked to assess Mrs Smith for a
laparotomy
• What else do you need to know?
• How do you plan to secure her airway?
• How will you asses her airway?

44. Case study 2
• You’re asked to come quickly to A&E because
‘there’s an unwell lady who needs to be
intubated’
• What else do you need to know?
• How do you plan to secure her airway?
• How will you asses the airway?

45. Common misunderstandings
“Can we have an anaesthetist to come and intubate
someone in A&E?”
“This kid’s only had sweets…can’t we do his operation
now?”
“This man has stridor and is blue but his sats are 95%
on 15L, so he’s OK, isn’t he?”

46. In conclusion, plan first so that
performance goes well!
“If you don’t know
where you are going,
any road will get you
there…”
Lewis Carroll