This document provides an overview of airway anatomy, equipment, and techniques for airway management. It discusses:
1. The importance of airway control and the development of advanced cardiac life support.
2. The objectives of reviewing upper and lower airway anatomy, basic and advanced airway techniques, equipment for difficult airways, and clinical management of the airway.
3. Details of upper airway structures including the nose, oral cavity, pharynx, and larynx. It also reviews lower airway structures like the trachea and lungs.
This document discusses the management of difficult airways. It begins with definitions of difficult airway situations according to the American Society of Anesthesiologists. It then discusses the prevalence, causes, and basic airway evaluation including the "Lemon Law" assessment. Management plans for anticipated difficult airways including having alternative intubation techniques ("Plan B" and "C") are covered. A gallery of tools for difficult intubation including different laryngoscope blades, supraglottic airways, and fiberoptic intubation are presented. The document concludes with discussions on unexpected difficult airways, the ASA difficult airway algorithm, and emphasizes being prepared with alternative intubation methods.
academic lecture about oxygen delivery system used in emergency room. The main principles of how to select proper device, the advatages and limitations of each device and how to monitor oxygen therapy.
The document provides information on the Laryngeal Mask Airway (LMA). It discusses the key features and design of the LMA, how to select the appropriate size, how to properly insert and secure the LMA, and how to manage the airway intraoperatively. Some potential complications are also outlined. In summary, the LMA is a supraglottic airway device that provides an alternative to face masks or endotracheal tubes to manage the airway during procedures requiring anesthesia. Proper technique and monitoring are important to ensure effective ventilation and patient safety.
1. Management of the difficult airway in critically ill patients is associated with significant morbidity and mortality, and incidence of difficult intubation during emergent procedures in the ICU is around 10%.
2. Prediction of a difficult airway involves evaluation of patient history, physical exam findings, and airway grading scales. Preparation includes deciding on the intubation strategy, assembling necessary equipment, and ensuring a plan is in place if initial attempts fail.
3. A variety of techniques can be practiced to optimize success of intubation and minimize complications, such as video laryngoscopy, supraglottic airways, and retrograde intubation. Having necessary equipment and trained staff available is important, especially in the ICU
This document discusses the anatomy and physiology of the airway and provides guidance on proper airway management techniques. It describes the structures of the airway from the nose to the trachea. It emphasizes the importance of evaluating each patient's airway, having the proper equipment, and developing adequate skills to successfully manage the airway. Techniques covered include use of oral and nasal airways, laryngoscopy, endotracheal intubation, and developing a backup plan for difficult airways.
This document provides an overview of basic airway management. It discusses the anatomy of the airway and respiratory system. Maintaining a patent airway is critical in trauma care as airway compromise can lead to death within minutes. Techniques like head tilt/chin lift and jaw thrust can help open the airway. Adjuncts like nasopharyngeal airways and oropharyngeal airways can also help maintain an open airway. Bag valve mask ventilation is an essential skill and should be used to provide oxygenation and ventilation when needed. End tidal CO2 monitoring is important for confirming proper airway placement and ventilation.
Percutaneous tracheostomy by Saja ALdulaijanMaher AlQuaimi
Percutaneous tracheostomy is a minimally invasive procedure that can be performed at the bedside to insert a tracheostomy tube. It involves using dilators of increasing size to gradually widen the incision and insert the tracheostomy tube. The Ciaglia and Griggs techniques are two common methods that use dilators over a guidewire to perform the procedure. Percutaneous tracheostomy has advantages over open surgical tracheostomy as it does not require transferring the patient to the operating room and has lower risks of complications like infection and stenosis. Proper patient positioning, identification of anatomical landmarks, and use of bronchoscopy are important for successful placement of the tracheostomy tube.
This document discusses various supraglottic airway devices (SGADs). It begins by comparing SGADs to face masks and endotracheal tubes, noting advantages and disadvantages of each. It then covers classifications of SGADs, specific devices like LMA Classic, ProSeal LMA, ILMA and Combitube. Placement techniques and complications are addressed. Key maneuvers like Chandys maneuver to optimize ILMA placement are explained.
This document discusses the management of difficult airways. It begins with definitions of difficult airway situations according to the American Society of Anesthesiologists. It then discusses the prevalence, causes, and basic airway evaluation including the "Lemon Law" assessment. Management plans for anticipated difficult airways including having alternative intubation techniques ("Plan B" and "C") are covered. A gallery of tools for difficult intubation including different laryngoscope blades, supraglottic airways, and fiberoptic intubation are presented. The document concludes with discussions on unexpected difficult airways, the ASA difficult airway algorithm, and emphasizes being prepared with alternative intubation methods.
academic lecture about oxygen delivery system used in emergency room. The main principles of how to select proper device, the advatages and limitations of each device and how to monitor oxygen therapy.
The document provides information on the Laryngeal Mask Airway (LMA). It discusses the key features and design of the LMA, how to select the appropriate size, how to properly insert and secure the LMA, and how to manage the airway intraoperatively. Some potential complications are also outlined. In summary, the LMA is a supraglottic airway device that provides an alternative to face masks or endotracheal tubes to manage the airway during procedures requiring anesthesia. Proper technique and monitoring are important to ensure effective ventilation and patient safety.
1. Management of the difficult airway in critically ill patients is associated with significant morbidity and mortality, and incidence of difficult intubation during emergent procedures in the ICU is around 10%.
2. Prediction of a difficult airway involves evaluation of patient history, physical exam findings, and airway grading scales. Preparation includes deciding on the intubation strategy, assembling necessary equipment, and ensuring a plan is in place if initial attempts fail.
3. A variety of techniques can be practiced to optimize success of intubation and minimize complications, such as video laryngoscopy, supraglottic airways, and retrograde intubation. Having necessary equipment and trained staff available is important, especially in the ICU
This document discusses the anatomy and physiology of the airway and provides guidance on proper airway management techniques. It describes the structures of the airway from the nose to the trachea. It emphasizes the importance of evaluating each patient's airway, having the proper equipment, and developing adequate skills to successfully manage the airway. Techniques covered include use of oral and nasal airways, laryngoscopy, endotracheal intubation, and developing a backup plan for difficult airways.
This document provides an overview of basic airway management. It discusses the anatomy of the airway and respiratory system. Maintaining a patent airway is critical in trauma care as airway compromise can lead to death within minutes. Techniques like head tilt/chin lift and jaw thrust can help open the airway. Adjuncts like nasopharyngeal airways and oropharyngeal airways can also help maintain an open airway. Bag valve mask ventilation is an essential skill and should be used to provide oxygenation and ventilation when needed. End tidal CO2 monitoring is important for confirming proper airway placement and ventilation.
Percutaneous tracheostomy by Saja ALdulaijanMaher AlQuaimi
Percutaneous tracheostomy is a minimally invasive procedure that can be performed at the bedside to insert a tracheostomy tube. It involves using dilators of increasing size to gradually widen the incision and insert the tracheostomy tube. The Ciaglia and Griggs techniques are two common methods that use dilators over a guidewire to perform the procedure. Percutaneous tracheostomy has advantages over open surgical tracheostomy as it does not require transferring the patient to the operating room and has lower risks of complications like infection and stenosis. Proper patient positioning, identification of anatomical landmarks, and use of bronchoscopy are important for successful placement of the tracheostomy tube.
This document discusses various supraglottic airway devices (SGADs). It begins by comparing SGADs to face masks and endotracheal tubes, noting advantages and disadvantages of each. It then covers classifications of SGADs, specific devices like LMA Classic, ProSeal LMA, ILMA and Combitube. Placement techniques and complications are addressed. Key maneuvers like Chandys maneuver to optimize ILMA placement are explained.
oxygen is a medication. oxygen therapy must be known to all health professionals for optimum management of patient and optimum use of resourses. even more oxygen can cause oxygen toxicity and can harm the patient in many ways. There are various methods for giving oxygen,varieties of face masks, cylinders. also there is criteria when to give oxygen ,how to give oxygen,what are the benefits and mechanism of oxygen therapy.
Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask or nasal mask. Learn more about NIV in this presentation by Dr Somnath Longani, consultant Anaesthesiologist & Intensivist, Midland Healthcare & Research Center, lucknow
https://midlandhealthcare.org/
The document discusses airway assessment for anesthesia. It defines the upper and lower airways and provides details on relevant anatomy. Key points of airway assessment are identified including patient history, external examination focusing on dentition, head and neck mobility. Specific tests like Mallampati score, thyromental distance and range of motion are described. The document emphasizes the importance of thorough airway assessment prior to procedures to anticipate difficult intubation. Advanced assessment methods involving imaging and fiberoptics are also mentioned.
This document discusses difficult airways and methods for assessing airway difficulty. It begins by defining difficult airway and difficult mask ventilation. It then discusses factors that can predispose patients to difficult airways, such as obesity, beard, missing teeth, snoring, and certain medical conditions.
The document outlines several tests and scoring systems that can be used to assess airway difficulty, including the Mallampatti test, thyromental distance, neck mobility, and inter-incisor distance. It provides details on how to perform and interpret these assessment tests. Finally, it discusses several scoring systems like LEMON, Wilson's criteria, and Benumof's 11 parameters that can help predict difficult laryngoscopy.
The document discusses the management of difficult airways. It defines difficult mask ventilation and difficult laryngoscopy/intubation. It describes various tests that can be used to assess a difficult airway, such as the Mallampati test, thyromental distance, sternomental distance, and neck mobility tests. Radiographic predictors of a difficult airway are also discussed, along with causes of difficult intubation related to patient anatomy and various medical conditions.
The document discusses airway management techniques including manual maneuvers to open the airway, use of suction and airway devices, oxygen delivery methods, endotracheal intubation procedure including equipment, technique, complications and confirmation of proper tube placement. The goal is to understand how to establish and maintain a patent airway through different airway management strategies and rescue techniques.
Airway assessment and pedictors of difficult airway....must know for anaesthe...drriyas03
This document discusses the importance of airway management expertise and outlines factors that can indicate a difficult airway. It notes that respiratory events are the second most common cause of injuries in anesthesia practice. Various anatomical measurements and assessments are described that can help predict a difficult airway, including Mallampati score, thyromental distance, neck mobility, and mandibular range of motion. Radiographic assessments like CT scans can also provide useful information. No single test is perfectly predictive, so anesthesiologists must always be prepared for an unanticipated difficult airway.
The document discusses airway management and ventilation, which are critical steps in assessing patients. It covers anatomy and physiology of the respiratory system, respiratory problems, and assessment techniques. Key points include the importance of establishing a patent airway and adequate breathing. Manual maneuvers like head-tilt chin-lift are described. Basic airway devices like oropharyngeal airways are presented. Methods of ventilation including bag-valve masks are covered. Advanced techniques like endotracheal intubation are discussed in detail, including indications, equipment, techniques, and verification of proper placement. Continuous monitoring of the airway is emphasized.
The document discusses identifying and managing difficult airways in emergency situations. It emphasizes the importance of predicting potential airway issues based on a patient's history and physical exam findings. Specific tests and factors that can help identify a difficult airway are described. The document also stresses having alternative plans for airway management if intubation is unsuccessful, such as using different techniques, devices, or establishing a surgical airway. Being prepared to promptly implement backup plans is key to managing life-threatening cannot intubate, cannot ventilate scenarios.
This document discusses high flow nasal cannula (HFNC) and humidification. It provides an overview of HFNC, including how it works and key points. HFNC can deliver high levels of oxygen and is well tolerated by patients. It has several benefits over traditional oxygen masks, including better washout of dead space and more consistent oxygen delivery. The document reviews indications, contraindications and complications of HFNC. It also discusses evidence on using HFNC to prevent intubation in respiratory failure, as peri-intubation support, and for post-extubation therapy. Risks, cleaning and questions around HFNC are also addressed.
This document provides an overview of pediatric airway management techniques. It discusses various oxygen delivery devices including nasal cannulas, simple oxygen masks, and non-rebreathing masks. Bag-valve mask ventilation is described including proper positioning and techniques. Intubation is covered, including equipment selection, laryngoscopy techniques, and confirmation of proper tube placement. Rescue airway devices like LMAs, Combitubes, and bougies are also summarized. Key rules for managing the pediatric airway emphasize being prepared, having backup plans, using common sense, and individualizing approaches for each patient.
This document discusses various airway management techniques including coughing, suctioning, artificial airways like oropharyngeal and nasopharyngeal tubes, endotracheal tubes, tracheostomy tubes, and alternative devices like LMAs and Combitubes. It provides details on the components of an effective cough, phases of suctioning, indications for different airway techniques, proper procedures, potential hazards, and equipment required.
Tracheal intubation has several advantages including maintaining airway patency, allowing for controlled ventilation, and providing a route for anesthesia administration. Potential complications include trauma during intubation, improper tube placement, laryngospasm, and post-intubation soreness. Proper preparation of equipment like laryngoscope blades, endotracheal tubes, and ventilation bags is important. The intubation technique involves positioning the patient, using a laryngoscope to visualize the vocal cords, and guiding the tube between the cords while ventilating and monitoring breath sounds.
Difficult airway management for nursing staffrashidmkhan
This document discusses strategies for managing difficult airways and intubation. It begins by outlining objectives of predicting difficult airways, choosing the appropriate technique and equipment, and having the skills to assist. The role of anesthesia nurses in assisting, providing equipment/drugs, and offering experience is described. Methods of predicting difficult airways like the LEMON system of examining facial anatomy, mouth opening, Mallampati score, and neck mobility are presented. The document recommends being prepared with suction, oxygen, airway devices, medications, and monitors. It details the contents and use of a difficult airway cart. Various airway devices that can be used when intubation fails like LMAs, Combitubes, intub
This document provides guidance on using various airway adjuncts, ventilation techniques, and supplemental oxygen during cardiac arrest or respiratory failure. It describes how to open the airway, insert oropharyngeal and nasopharyngeal airways, perform endotracheal intubation, use bag-valve-mask ventilation and mouth-to-mask techniques, provide tracheobronchial suctioning, and confirm proper tracheal tube placement. The goal is to control the airway, optimize ventilation, and effectively deliver supplemental oxygen during emergencies."
This document discusses different types of breathing systems used in anaesthesia. It describes the components and ideal properties of breathing systems. Open, semi-open, and semi-closed systems are defined. Several specific semi-open systems are outlined, including the Mapleson A, D, F systems. Semi-closed systems require CO2 absorbents and lower fresh gas flows than open systems. Types of semi-closed systems are also defined. The document emphasizes the importance of ensuring tight connections between breathing system components.
This document provides an overview of airway management techniques. It begins with airway anatomy and assessment. It then covers oxygenation and ventilation methods like nasal cannulas, oxygen masks, and bag valve masks. The document details basic airway maneuvers such as head tilt/chin lift and suctioning. Airway adjuncts like oropharyngeal and nasopharyngeal airways are also described. Advanced techniques covered include laryngoscopy, endotracheal intubation procedure, and calling for help during difficult intubations to prioritize oxygenation.
The document provides guidance on airway management in emergency situations. It discusses assessing the need for airway control, oxygen delivery devices, signs of respiratory distress, techniques for difficult intubation like video laryngoscopy, and alternative airway devices like combitubes. Factors like patient comorbidities, anatomy, and mechanism of respiratory failure help determine the best approach. Proper planning, backup devices, and skills are important for managing challenging airways.
CPAP therapy provides positive airway pressure throughout the respiratory cycle to help stabilize the lungs. It has various physiological effects like decreasing respiratory rate and increasing functional residual capacity. CPAP can be applied through nasal prongs, masks, or endotracheal tubes. It is commonly used to treat respiratory distress syndrome, meconium aspiration syndrome, and apnea of prematurity. Optimal CPAP levels depend on the underlying lung disease and physiology. CPAP is generally well-tolerated but high levels can cause side effects like air leaks or decreased cardiac output. Close monitoring is needed when applying and weaning infants from CPAP support.
The document provides information on the respiratory system, including its structures and functions. It discusses the processes of ventilation, external respiration, transport of gases, and cellular respiration. It describes the structures of the upper respiratory tract such as the nose, pharynx and larynx. It also details the trachea, bronchi, bronchioles, and alveoli. Furthermore, it examines the muscles involved in inspiration and expiration, respiratory volumes and capacities, and the control of breathing.
oxygen is a medication. oxygen therapy must be known to all health professionals for optimum management of patient and optimum use of resourses. even more oxygen can cause oxygen toxicity and can harm the patient in many ways. There are various methods for giving oxygen,varieties of face masks, cylinders. also there is criteria when to give oxygen ,how to give oxygen,what are the benefits and mechanism of oxygen therapy.
Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask or nasal mask. Learn more about NIV in this presentation by Dr Somnath Longani, consultant Anaesthesiologist & Intensivist, Midland Healthcare & Research Center, lucknow
https://midlandhealthcare.org/
The document discusses airway assessment for anesthesia. It defines the upper and lower airways and provides details on relevant anatomy. Key points of airway assessment are identified including patient history, external examination focusing on dentition, head and neck mobility. Specific tests like Mallampati score, thyromental distance and range of motion are described. The document emphasizes the importance of thorough airway assessment prior to procedures to anticipate difficult intubation. Advanced assessment methods involving imaging and fiberoptics are also mentioned.
This document discusses difficult airways and methods for assessing airway difficulty. It begins by defining difficult airway and difficult mask ventilation. It then discusses factors that can predispose patients to difficult airways, such as obesity, beard, missing teeth, snoring, and certain medical conditions.
The document outlines several tests and scoring systems that can be used to assess airway difficulty, including the Mallampatti test, thyromental distance, neck mobility, and inter-incisor distance. It provides details on how to perform and interpret these assessment tests. Finally, it discusses several scoring systems like LEMON, Wilson's criteria, and Benumof's 11 parameters that can help predict difficult laryngoscopy.
The document discusses the management of difficult airways. It defines difficult mask ventilation and difficult laryngoscopy/intubation. It describes various tests that can be used to assess a difficult airway, such as the Mallampati test, thyromental distance, sternomental distance, and neck mobility tests. Radiographic predictors of a difficult airway are also discussed, along with causes of difficult intubation related to patient anatomy and various medical conditions.
The document discusses airway management techniques including manual maneuvers to open the airway, use of suction and airway devices, oxygen delivery methods, endotracheal intubation procedure including equipment, technique, complications and confirmation of proper tube placement. The goal is to understand how to establish and maintain a patent airway through different airway management strategies and rescue techniques.
Airway assessment and pedictors of difficult airway....must know for anaesthe...drriyas03
This document discusses the importance of airway management expertise and outlines factors that can indicate a difficult airway. It notes that respiratory events are the second most common cause of injuries in anesthesia practice. Various anatomical measurements and assessments are described that can help predict a difficult airway, including Mallampati score, thyromental distance, neck mobility, and mandibular range of motion. Radiographic assessments like CT scans can also provide useful information. No single test is perfectly predictive, so anesthesiologists must always be prepared for an unanticipated difficult airway.
The document discusses airway management and ventilation, which are critical steps in assessing patients. It covers anatomy and physiology of the respiratory system, respiratory problems, and assessment techniques. Key points include the importance of establishing a patent airway and adequate breathing. Manual maneuvers like head-tilt chin-lift are described. Basic airway devices like oropharyngeal airways are presented. Methods of ventilation including bag-valve masks are covered. Advanced techniques like endotracheal intubation are discussed in detail, including indications, equipment, techniques, and verification of proper placement. Continuous monitoring of the airway is emphasized.
The document discusses identifying and managing difficult airways in emergency situations. It emphasizes the importance of predicting potential airway issues based on a patient's history and physical exam findings. Specific tests and factors that can help identify a difficult airway are described. The document also stresses having alternative plans for airway management if intubation is unsuccessful, such as using different techniques, devices, or establishing a surgical airway. Being prepared to promptly implement backup plans is key to managing life-threatening cannot intubate, cannot ventilate scenarios.
This document discusses high flow nasal cannula (HFNC) and humidification. It provides an overview of HFNC, including how it works and key points. HFNC can deliver high levels of oxygen and is well tolerated by patients. It has several benefits over traditional oxygen masks, including better washout of dead space and more consistent oxygen delivery. The document reviews indications, contraindications and complications of HFNC. It also discusses evidence on using HFNC to prevent intubation in respiratory failure, as peri-intubation support, and for post-extubation therapy. Risks, cleaning and questions around HFNC are also addressed.
This document provides an overview of pediatric airway management techniques. It discusses various oxygen delivery devices including nasal cannulas, simple oxygen masks, and non-rebreathing masks. Bag-valve mask ventilation is described including proper positioning and techniques. Intubation is covered, including equipment selection, laryngoscopy techniques, and confirmation of proper tube placement. Rescue airway devices like LMAs, Combitubes, and bougies are also summarized. Key rules for managing the pediatric airway emphasize being prepared, having backup plans, using common sense, and individualizing approaches for each patient.
This document discusses various airway management techniques including coughing, suctioning, artificial airways like oropharyngeal and nasopharyngeal tubes, endotracheal tubes, tracheostomy tubes, and alternative devices like LMAs and Combitubes. It provides details on the components of an effective cough, phases of suctioning, indications for different airway techniques, proper procedures, potential hazards, and equipment required.
Tracheal intubation has several advantages including maintaining airway patency, allowing for controlled ventilation, and providing a route for anesthesia administration. Potential complications include trauma during intubation, improper tube placement, laryngospasm, and post-intubation soreness. Proper preparation of equipment like laryngoscope blades, endotracheal tubes, and ventilation bags is important. The intubation technique involves positioning the patient, using a laryngoscope to visualize the vocal cords, and guiding the tube between the cords while ventilating and monitoring breath sounds.
Difficult airway management for nursing staffrashidmkhan
This document discusses strategies for managing difficult airways and intubation. It begins by outlining objectives of predicting difficult airways, choosing the appropriate technique and equipment, and having the skills to assist. The role of anesthesia nurses in assisting, providing equipment/drugs, and offering experience is described. Methods of predicting difficult airways like the LEMON system of examining facial anatomy, mouth opening, Mallampati score, and neck mobility are presented. The document recommends being prepared with suction, oxygen, airway devices, medications, and monitors. It details the contents and use of a difficult airway cart. Various airway devices that can be used when intubation fails like LMAs, Combitubes, intub
This document provides guidance on using various airway adjuncts, ventilation techniques, and supplemental oxygen during cardiac arrest or respiratory failure. It describes how to open the airway, insert oropharyngeal and nasopharyngeal airways, perform endotracheal intubation, use bag-valve-mask ventilation and mouth-to-mask techniques, provide tracheobronchial suctioning, and confirm proper tracheal tube placement. The goal is to control the airway, optimize ventilation, and effectively deliver supplemental oxygen during emergencies."
This document discusses different types of breathing systems used in anaesthesia. It describes the components and ideal properties of breathing systems. Open, semi-open, and semi-closed systems are defined. Several specific semi-open systems are outlined, including the Mapleson A, D, F systems. Semi-closed systems require CO2 absorbents and lower fresh gas flows than open systems. Types of semi-closed systems are also defined. The document emphasizes the importance of ensuring tight connections between breathing system components.
This document provides an overview of airway management techniques. It begins with airway anatomy and assessment. It then covers oxygenation and ventilation methods like nasal cannulas, oxygen masks, and bag valve masks. The document details basic airway maneuvers such as head tilt/chin lift and suctioning. Airway adjuncts like oropharyngeal and nasopharyngeal airways are also described. Advanced techniques covered include laryngoscopy, endotracheal intubation procedure, and calling for help during difficult intubations to prioritize oxygenation.
The document provides guidance on airway management in emergency situations. It discusses assessing the need for airway control, oxygen delivery devices, signs of respiratory distress, techniques for difficult intubation like video laryngoscopy, and alternative airway devices like combitubes. Factors like patient comorbidities, anatomy, and mechanism of respiratory failure help determine the best approach. Proper planning, backup devices, and skills are important for managing challenging airways.
CPAP therapy provides positive airway pressure throughout the respiratory cycle to help stabilize the lungs. It has various physiological effects like decreasing respiratory rate and increasing functional residual capacity. CPAP can be applied through nasal prongs, masks, or endotracheal tubes. It is commonly used to treat respiratory distress syndrome, meconium aspiration syndrome, and apnea of prematurity. Optimal CPAP levels depend on the underlying lung disease and physiology. CPAP is generally well-tolerated but high levels can cause side effects like air leaks or decreased cardiac output. Close monitoring is needed when applying and weaning infants from CPAP support.
The document provides information on the respiratory system, including its structures and functions. It discusses the processes of ventilation, external respiration, transport of gases, and cellular respiration. It describes the structures of the upper respiratory tract such as the nose, pharynx and larynx. It also details the trachea, bronchi, bronchioles, and alveoli. Furthermore, it examines the muscles involved in inspiration and expiration, respiratory volumes and capacities, and the control of breathing.
The document provides information on the respiratory system including its structures, functions, and mechanisms of breathing. Some key points:
1. The respiratory system includes the nose, pharynx, larynx, trachea, bronchi, lungs, and muscles of respiration. Gas exchange occurs in the alveoli of the lungs.
2. Breathing is controlled by respiratory centers in the brain and involves inspiration and expiration. Inspiration is driven by contraction of the diaphragm and intercostal muscles which increase the thoracic cavity. Expiration occurs passively.
3. The lungs contain alveoli where oxygen and carbon dioxide diffuse between the air and blood through the respiratory membrane. Various factors can impact
The document provides information on the respiratory system including its structures, functions, and control. It describes the major events of inspiration and expiration. The respiratory system works to oxygenate tissues and remove carbon dioxide through a process involving the nose, pharynx, larynx, trachea, bronchi, lungs and related muscles and nerves. Breathing is controlled by respiratory centers in the brainstem that detect changes in blood gases and stretch receptors in the lungs.
The document provides an overview of airway anatomy and management. It begins with a review of upper and lower airway anatomy, highlighting key structures like the pharynx, larynx, trachea, and bronchi. It also discusses important differences in pediatric airway anatomy compared to adults. The document then covers objectives and contents for a presentation on airway management, including initial airway techniques, advanced airway management with intubation, and management of airways in special situations like head trauma. The goal is to refresh knowledge of airway equipment and techniques to allow providers to manage a patient's airway effectively.
The respiratory system consists of the upper and lower respiratory tract. The upper tract includes the nose, nasal cavity, pharynx and larynx. The lower tract includes the trachea, bronchi and lungs. The nose warms, moistens and filters inhaled air. The nasal cavity is lined with turbinates and openings of paranasal sinuses. The pharynx is divided into naso, oro and laryngopharynx. The larynx contains cartilages including the thyroid, cricoid and epiglottis and controls airflow into the trachea and esophagus. The trachea begins at the cricoid cartilage and contains incomplete C-shaped cartilaginous rings extending
1. The document summarizes the anatomy and physiology of the airway and ventilation. It describes the structures of the upper airway from the nose to the larynx and lower airway structures including the trachea, bronchi, and lungs.
2. It explains the mechanics of breathing including lung volumes, the regulation of ventilation, and how gas exchange occurs in the alveoli.
3. Key concepts covered are the phases of breathing, how ventilation is controlled both chemically and neurologically, and the passive and active processes involved in inhalation and exhalation.
This document provides an overview of the physiology of the respiratory system. It begins with the anatomical structures of the respiratory tract, including the nasal cavity, pharynx, larynx, trachea, bronchi, bronchioles, alveolar ducts and alveoli. It then describes the mechanics of ventilation, including how the diaphragm and intercostal muscles cause inhalation and exhalation through changes in thoracic cavity volume. Finally, it discusses pulmonary volumes such as tidal volume, vital capacity, functional residual capacity, and their clinical measurements using spirometry.
The document summarizes the anatomy and functions of the upper airway. It describes the components of the upper airway, including the nose, nasopharynx, oropharynx, laryngopharynx, and larynx. It then discusses the muscles that control airway patency, consequences of loss of muscle tone, cartilage/ligaments of the larynx, intrinsic/extrinsic muscles, and innervation of the larynx.
This document provides an overview of airway anatomy and evaluation. It describes the important structures of the upper and lower airways, including the oral cavity, nasal cavity, pharynx, larynx, trachea, bronchi and lungs. Key differences between adult and pediatric airways are highlighted. Understanding airway anatomy is fundamental for anesthesiologists to ensure airway patency and adequate ventilation and oxygenation. Airway evaluation is necessary to diagnose potential difficult airways and allow for optimal patient preparation and equipment selection.
The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies greatly, depending on the size of the organism, the environment in which it lives and its evolutionary history. In land animals the respiratory surface is internalized as linings of the lungs. Gas exchange in the lungs occurs in millions of small air sacs; in mammals and reptiles these are called alveoli, and in birds they are known as atria. These microscopic air sacs have a very rich blood supply, thus bringing the air into close contact with the blood.These air sacs communicate with the external environment via a system of airways, or hollow tubes, of which the largest is the trachea, which branches in the middle of the chest into the two main bronchi. These enter the lungs where they branch into progressively narrower secondary and tertiary bronchi that branch into numerous smaller tubes, the bronchioles. In birds the bronchioles are termed parabronchi. It is the bronchioles, or parabronchi that generally open into the microscopic alveoli in mammals and atria in birds. Air has to be pumped from the environment into the alveoli or atria by the process of breathing which involves the muscles of respiration.
In most fish, and a number of other aquatic animals (both vertebrates and invertebrates) the respiratory system consists of gills, which are either partially or completely external organs, bathed in the watery environment. This water flows over the gills by a variety of active or passive means. Gas exchange takes place in the gills which consist of thin or very flat filaments and lammelae which expose a very large surface area of highly vascularized tissue to the water.
Other animals, such as insects, have respiratory systems with very simple anatomical features, and in amphibians even the skin plays a vital role in gas exchange. Plants also have respiratory systems but the directionality of gas exchange can be opposite to that in animals. The respiratory system in plants includes anatomical features such as stomata, that are found in various parts of the plant.
Review of lungs anatomy and physiology- Easy explanation for students
Introduction
Anatomy
Air movement through Lungs
Physiology of Respiration
Assessment of Respiratory System
The document describes the anatomy and physiology of the respiratory system. It discusses the structures of the respiratory system including the upper and lower airways, pleura, lungs, thorax, diaphragm and respiratory centers. It also describes the processes of respiration including ventilation, diffusion, and gas exchange. Furthermore, it outlines how to assess a client with a respiratory disorder through obtaining history, performing a physical exam including inspection, palpation, percussion and auscultation of breath sounds.
Anatomically the respiratory system is divided into
Upper respiratory tract
From the nostril to the vocal cord
Lower respiratory tract
The lower respiratory tract is from bellow the vocal cord upto the alveoli
The document provides an overview of the anatomy and physiology of the respiratory system. It discusses the main organs and structures involved, including the nose, pharynx, larynx, trachea, bronchi, lungs, diaphragm, and intercostal muscles. It describes the processes of breathing, gas exchange, and lung volumes. Key functions of the respiratory system are to oxygenate tissues and remove carbon dioxide through external respiration in the lungs and internal respiration in tissues. Respiratory disorders like COPD that impact lung function are also summarized.
This document provides an overview of human airway anatomy, beginning with the upper airway including the nose, oral cavity, pharynx and larynx, and then describing the lower airway including the trachea, bronchi and lungs. It discusses the anatomy of each structure in detail, including cartilage, muscles, nerves and vasculature. It also covers anatomical variations, airway assessment techniques, and considerations for airway management in different patient populations such as neonates, pregnant patients, and those with potential spinal injuries.
The respiratory system consists of organs and structures used for gas exchange. The major organs are the nose, pharynx, larynx, trachea, bronchi, bronchioles and lungs. Respiration is the process of oxygen intake and carbon dioxide output. The lungs are divided into lobes and receive air via the trachea which branches into bronchi and bronchioles. Gas exchange occurs in the alveoli via diffusion across the respiratory membrane. The pleura surrounds each lung and allows for lung movement during breathing.
1. Perform a thorough airway assessment to evaluate any anatomical variations or difficulties that may be encountered. This includes evaluating mouth opening, neck mobility, Mallampati score, and other tests.
2. Prepare all necessary airway equipment like laryngoscopes, endotracheal tubes, stylets, laryngeal mask airways etc and have them checked and ready to use.
3. Pre-oxygenate the patient with 100% oxygen for 3-5 minutes to denitrogenate the lungs.
4. Induce anesthesia and provide muscle relaxation while maintaining oxygenation with a facemask or other device.
5
The document discusses the anatomy and physiology of the respiratory system. It describes the functions of the respiratory system as air distribution, gas exchange, filtering and warming air, influencing speech, and allowing for smell. It then outlines the divisions of the respiratory system into the upper respiratory tract including the nose, nasal cavity, sinuses, pharynx and larynx, and the lower respiratory tract within the thorax including the trachea, bronchial tree and lungs. Several structures of the upper and lower respiratory tract are defined such as the larynx, trachea, bronchi and lungs. Pulmonary ventilation and the mechanics of breathing including inspiration and expiration are explained.
Similar to Appropriate airway equipment and techniques. (20)
This document discusses airway local blocks and awake intubation. It describes the indications for awake intubation including comorbidities, risk of aspiration, difficult airway assessment, and emergencies. It provides details on the pharmacological agents, equipment, personnel, and techniques used for airway local blocks and awake intubation. Specifically, it outlines common methods for anesthetizing different areas of the airway using lidocaine, including dosage calculations and risks of lidocaine toxicity. The goal is to safely anesthetize the airway to allow for awake intubation.
This document discusses endotracheal tubes and intubation. It covers indications for intubation including airway protection, optimizing gas exchange, decreasing metabolic demand, and reducing work of breathing. Conditions associated with difficult intubation are described such as congenital anomalies, infections, tumors, injuries, and obesity. Proper equipment, tube sizing, intubation technique including positioning and confirmation of placement are outlined. Golden rules of intubation emphasize preparation, oxygenation, skills, confirmation, and monitoring.
- The laryngeal mask airway (LMA) is a supraglottic airway device that is placed in the hypopharynx to control the airway during general anesthesia or ventilation. It provides an alternative to endotracheal intubation or use of a face mask. The LMA has advantages like ease of insertion, reduced hemodynamic response, and improved oxygenation during emergence from anesthesia. Potential complications include sore throat, coughing, laryngospasm, and airway obstruction. Proper selection of size, lubrication, and insertion technique are important for successful use of the LMA.
This document discusses different types of fluid flow and transport mechanisms in cells. It describes laminar and turbulent fluid flow, how they are characterized, and factors that influence each type. It also outlines different transport mechanisms in cells including diffusion, osmosis, facilitated diffusion, active transport, endocytosis, and exocytosis. Active transport uses carrier proteins and cell energy to move substances against a concentration gradient, while passive transport moves substances down a concentration gradient without cell energy.
1. The document discusses theories of anesthesia including the unitary theory and modern theories involving interactions with membrane proteins and specific ion channels.
2. It describes the stages of general anesthesia from analgesia to surgical anesthesia to medullary respiratory paralysis. However, it notes that the excitement stage is rarely seen with modern anesthesia.
3. GABA receptors are identified as an important target for many anesthetic agents. General anesthetics bind to these receptors, causing chloride channel opening and neuronal inhibition, resulting in anesthesia.
Endotracheal intubation and laryngoscopy part 2Nisar Arain
This document discusses various types of endotracheal tubes and laryngoscopy techniques. It describes specialized tubes like armored tubes, RAE tubes, Oxford tubes, and laser-resistant tubes. It covers direct laryngoscopy using curved and straight blades. Optimal conditions for laryngoscopy are outlined, including using the appropriately sized blade and ensuring good muscle relaxation. Reliable signs of correct endotracheal tube placement include capnography, visualization of the tube passing the vocal cords, and fiberoptic bronchoscopy visualization of tracheal rings.
Endotracheal tubes are used to intubate patients and enable ventilation. They are typically made of PVC or rubber and have features like a Murphy eye, size designations, and a pilot balloon-connected inflation system to create a seal in the trachea. Complications can occur during or after intubation and extubation, like trauma, aspiration, or laryngospasm. Nasotracheal intubation has advantages like patient comfort but risks like trauma or sinusitis. Proper preparation, techniques, and monitoring are important for safe endotracheal intubation.
Complications of artificial applications part 5Nisar Arain
This document discusses the complications that can arise from mechanical ventilation through either invasive or non-invasive means. Some key complications mentioned include pneumonia, infections, injuries to the face/lips/pharynx and larynx/trachea, gastrointestinal effects like esophagitis and decreased motility, renal effects from reductions in blood pressure/flow, disrupted sleep, and decubitus ulcers. Proper diagnosis and management of these various complications is important for patients receiving mechanical ventilation support.
This document discusses endotracheal tubes and intubation. It covers indications for intubation including airway protection, optimizing gas exchange, decreasing metabolic demand, and reducing work of breathing. Conditions associated with difficult intubation are described such as congenital anomalies, infections, tumors, and injuries. Airway assessment techniques like mallampati classification, laryngoscopy view, and thyromental distance are explained. Equipment for intubation and sizing endotracheal tubes are outlined. The technique of intubation is described involving positioning the patient in sniffing position and using a laryngoscope to visualize the vocal cords. Confirmation of proper tube placement is emphasized using methods like auscultation and capnography.
This document discusses various techniques for airway management. It describes mechanical maneuvers like jaw thrust and head tilt-chin lift to clear obstructions. Common airway adjuncts like oropharyngeal and nasopharyngeal airways are also discussed. Guidelines are provided for sizing and inserting these adjuncts safely. Face masks can be used with one, two, or three hands to maintain a patent airway. Risk factors for difficult mask ventilation and potential complications are also outlined.
This document discusses airway assessment and difficult airways. It outlines various predictors of difficult airways like obesity, short neck, and facial hair. It describes tests to evaluate the airway like thyromental distance, inter-incisor gap, and Mallampati grading. The document emphasizes the importance of a thorough airway assessment prior to intubation to identify potential difficulties and prepare appropriate management strategies for difficult intubations.
The document discusses preoperative airway assessment for anesthesia. It notes that 1-3 out of 100 anesthetized patients have difficult intubation, while 1 out of 1000 have failed intubation and 1 out of 10,000 experience cannot intubate cannot ventilate scenarios. Factors that can increase intubation difficulty include congenital syndromes, anatomical features like teeth and neck structure, and acquired conditions such as decreased jaw or neck mobility. A thorough preoperative assessment including tests of mouth opening, neck movement, thyromental distance, and Mallampati score can help predict and prepare for a potentially difficult airway.
- Imhotep, an ancient Egyptian priest from around 2600 BC, is considered the first physician and treated many diseases. He extracted medicines from plants and had knowledge of anatomy. Ancient Egyptians used opium and hyoscyamus for anesthesia and performed trepanation surgery.
- In ancient Greece and Rome, mandrake juice was used for its narcotic effects before surgeries to ensure insensibility to pain. Arabic translations of Greek medicine advanced Islamic medicine in the Middle Ages. Physicians like Al Zahrawi described many surgeries and instruments.
- The modern history of anesthesia began with William Morton using ether in 1846 and John Snow advancing the field through publications on ether and chlor
This document discusses different types of anesthesia including local, regional, and general anesthesia. It provides details on common regional anesthesia techniques like spinal blocks, epidurals, and caudal blocks. It also describes local anesthesia techniques such as infiltration, nerve blocks, and intravenous regional anesthesia. The document discusses the mechanisms of local anesthetics and some potential complications as well as benefits of local and regional anesthesia compared to general anesthesia.
This document discusses the problem of anesthesia awareness during surgery. It defines anesthesia awareness as a patient becoming conscious during a surgical procedure under general anesthesia and having recall of events. Risk factors include women, younger age, use of total intravenous anesthesia, long surgeries, prior awareness history, and natural red hair. Causes can include light anesthesia, increased anesthetic requirements, or anesthesiologist error. Prevention strategies include pre-operative evaluation, prophylactic benzodiazepines, monitoring anesthetic levels, and post-operative interviews. Methods to monitor consciousness include clinical signs, isolated forearm technique, brain monitoring like BIS, and measurements of lower esophageal sphincter contractions.
- The document discusses various physiological changes that occur with aging and their implications for anesthesia in geriatric patients. Some key points discussed include:
- Cardiovascular changes like decreased cardiac output and increased risk of hypertension. Respiratory changes like reduced lung capacity and cough reflex. Genitourinary changes like reduced kidney function and bladder issues.
- Gastrointestinal changes like decreased motility leading to constipation. Endocrine changes like increased risk of hypothyroidism and bone issues.
- The implications of these changes for anesthesia include risks of hypotension, bradycardia, respiratory complications, slower drug metabolism and clearance, and risks of gastric aspiration and constipation. Careful preoperative evaluation and
The document provides information on general anesthesia including:
1) It discusses the history, goals, and levels of sedation for general anesthesia. Different levels include minimal sedation, moderate sedation, deep sedation, and general anesthesia.
2) The pre-anesthetic evaluation process involves taking a medical history, performing a physical exam including airway assessment, and ordering lab tests.
3) Common anesthetic equipment is described including laryngoscopes, endotracheal tubes, airways, monitors, and intravenous and inhalational drugs used for induction and maintenance of general anesthesia.
The document discusses body temperature regulation and abnormalities. It notes that humans maintain a constant core body temperature of around 37°C through heat gain and loss mechanisms controlled by the hypothalamus. When temperature varies by 0.1°C from the set point, the hypothalamus activates heat conservation or dissipation responses. Disorders include hypothermia, where temperature drops below the normal range, and hyperthermia/fever, where the hypothalamus raises the set point in response to pyrogens like bacterial toxins or cytokines. Heat stroke occurs when temperature exceeds the critical threshold of around 105-108°F.
This document discusses triage, which is the process of sorting patients based on the urgency of their condition to prioritize care. It defines triage and outlines its objectives to identify patients, prioritize their needs, track their progress, and identify hazards. It describes different types of triage including simple, advanced, continuous integrated, and reverse triage. It discusses levels of triage from red to green based on factors like vital signs and Glasgow Coma Scale. Finally, it outlines the role and characteristics of EMTs in effectively conducting triage.
The document discusses the design and setup of an operation theatre. It outlines key areas that should be included like an anesthesia room, sterilization room, recovery room, and storeroom. It also describes the daily, weekly, and deep cleaning procedures needed to properly sanitize the operation theatre and prevent infections. Furthermore, it covers the preparation of equipment, instruments, and supplies as well as different sterilization methods like autoclaving, gamma irradiation, and ethylene oxide.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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