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AWM Wht How for best to goooof. 2021.ppt
- 1. AIRWAY MANAGEMENT HOSSAM EL-DINFOUAD RIDA DEPARTMENT OF ANESTHESIA & SURGICAL INTENSIVE CARE, FACULTY OF MEDICINE ALEXANDRIA UNIVERSITY
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- 3. • PROPER ANDEFFICIENT AIRWAY MANAGEMENT IS AN ESSENTIAL SKILL. • IT IS THE FIRST STEP WHEN DEALING WITH UNCONSCIOUS , TRAUMATIZED OR SEVERELY INJURED PATIENTS. • LOSS OF PATENT AIRWAY CAN LEAD TO LIFE THREATENING HYPOXIA.
- 4. BASIC AIRWAY MANAGEMENT •AIRWAYS: CONDUCT AIR, OUTSIDE & INSIDE BODY (INTO & OUT OF THE LUNGS) •Inspired O Inspired O2 2 = 20% = 20% •BRAIN can not tolerate BRAIN can not tolerate Hypoxia ›4 min Hypoxia ›4 min • Expired O Expired O2 2 =16% =16%
- 5. COMMON CAUSES OFAIRWAY OBSTRUCTION • UPPER AIRWAY • TONGUE • FOREIGN MATERIAL ,SOFT TISSUE OEDEMA • BLOOD, VOMIT • LARYNX • FOREIGN BODY, LARYNGOSPASM • LOWER AIRWAY - SECRETIONS, OEDEMA, BRONCHOSPASM, ASPIRATION,…
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- 7. RECOGNITION OF AIRWAYOBSTRUCTION LOOK, LISTEN & FEEL
- 8. RECOGNITION OF AIRWAYOBSTRUCTION LOOK Chest / Abdominal Movement LISTEN Breath Sounds , at mouth and nose Snoring, gurgling FEEL Mouth / Nose for expired air
- 9. SIGNS OF RESPIRATORYOBSTRUCTION 1. SNORING OR GURGLE 2. STRIDOR OR ABNORMAL BREATH SOUNDS 3. AGITATION (HYPOXIA) 4. ACCESSORY MUSCLES 5. PARADOXICAL BREATHING 6. CYANOSIS
- 10. MANAGEMENT OF RESPIRATORY OBSTRUCTION •Exclude Foreign Body Exclude Foreign Body • No Sedation No Sedation • Urgent Treatment Urgent Treatment Open airway Open airway Check for breathing Check for breathing • Always Reassess Always Reassess Seek help Seek help
- 11. MANAGEMENT OF RESPIRATORY OBSTRUCTION Respiratory Respiratory Obstruction Obstruction BasicTechniques Devices Basic Oropharyngeal/ Oropharyngeal/ Nasopharyngeal Nasopharyngeal Airway Airway Advanced LMA LMA Combi tube Combi tube ETT ETT Head tilt-Chin Lift Head tilt-Chin Lift Jaw Thrust
- 12. OPENING THE AIRWAY •HEAD TILT / CHIN LIFT OR JAW THRUST • THEY ARE BASIC MANOEUVRES USED TO MANAGE AIRWAY OBSTRUCTION CAUSED BY BACKWARD FALL OF THE TONGUE IN UNCONSCIOUS VICTIM.
- 14. Head Tilt andChin Lift
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- 17. • CAUTION! –JAWTHRUST IS DONE IF THERE IS SUSPECTED CERVICAL SPINE INJURY • MANUAL IN LINE STABILIZATION BY ASSISTANT MUST BE DONE. • DEATH FROM HYPOXIA > FROM CERVICAL SPINAL CORD INJURY
- 18. SIMPLE AIRWAY ADJUNCTS •THE OROPHARYNGEAL AND NASOPHARYNGEAL AIRWAYS ARE USED TO MANAGE AIRWAY OBSTRUCTION CAUSED BY THE TONGUE IN UNCONSCIOUS PATIENTS.
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- 23. OROPHARYNGEAL AIRWAY • SIZETHE AIRWAY BY MEASURING THE DISTANCE FROM THE INCISORS TO THE ANGLE OF THE JAW. • INSERT THE AIRWAY SO THAT ITS CONCAVE SIDE FACES AWAY FROM THE TONGUE. • INSERT THE AIRWAY INTO THE MOUTH TO APPROXIMATELY ONE-THIRD OF ITS LENGTH. WHILST GENTLY PUSHING THE AIRWAY FURTHER IN, ROTATE IT 180° AND SLIDE IT IN TO ITS FULL EXTENT.
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- 26. NASOPHARYNGEAL AIRWAY • SIZETHE AIRWAY BY MEASURING THE DISTANCE FROM THE NOSTRIL TO THE LOBULE OF THE EAR. • CHOOSE A DIAMETER LIKE THE LITTLE FINGER OF THE VICTIM. • LUBRICATE AND INSERT.
- 27. • AFTER MANAGINGAIRWAY OBSTRUCTION , IF BREATHING IS NOT ADEQUATE, WE MUST VENTILATE THE PATIENT. • WE CAN DO: • MOUTH TO MOUTH BREATHING, • USE POCKET MASK OR • USE AMBU BAG.
- 28. MOUTH TO MOUTHBREATHING: ( + FACE SHIELD… ?? )
- 30. MOUTH TO MASKVENTILATION ADVANTAGES: • AVOIDS DIRECT PERSON TO PERSON CONTACT • DECREASES POTENTIAL FOR CROSS INFECTION • ALLOWS OXYGEN ENRICHMENT LIMITATIONS: • MAINTENANCE OF AIRTIGHT SEAL • GASTRIC INFLATION WITH AIR.
- 31. • SELF-INFLATING BAG& MASK
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- 33. • VENTILATION: SELFINFLATING BAG Advantages Advantages •Avoids direct person Avoids direct person to person contact to person contact •O O2 2 supplementation supplementation •Can be used with Can be used with Facemask, LMA, Facemask, LMA, Combitube, tracheal Combitube, tracheal tube tube Limitations Limitations With facemask: With facemask: •Inadequate Inadequate ventilation ventilation •Gastric inflation Gastric inflation with air with air •Two persons for Two persons for optimal use optimal use
- 34. ADVANCED DEVICES. • THELARYNGEAL MASK AIRWAY • COMBITUBE , LARYNGEAL TUBE • ENDOTRACHEAL INTUBATION
- 35. THE THE LARYNGEAL MASK AIRWAY LARYNGEALMASK AIRWAY LMA LMA
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- 38. Device preparation: Partial deflation Lubrication Patientpreparation: Areflexia Position Procedure: Hold LMA like a pen Slippery movement against …. Remove finger Inflate (LMA) and ventilate (patient)
- 39. LIMITATIONS • ASPIRATION RISK •NOT SUITABLE WITH VERY HIGH INFLATION PRESSURES • UNABLE TO ASPIRATE AIRWAY LMA LMA Advantages Advantages • Blind insertion Blind insertion • Rapid & easy Rapid & easy insertion insertion • Variable sizes Variable sizes • Ventilation > Ventilation > facemask facemask • Avoids Avoids laryngoscopy laryngoscopy
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- 42. COMBITUBE ADVANTAGES • RAPID &EASY INSERTION • AVOIDS LARYNGOSCOPY • PROTECTS AGAINST ASPIRATION • CAN BE USED WITH HIGH INFLATION PRESSURES Limitations Limitations • 2 sizes only 2 sizes only • Ventilation via wrong Ventilation via wrong lumen lumen • Damage to cuffs Damage to cuffs • Trauma Trauma • Single use Single use
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- 45. • THE GOLDSTANDARD
- 47. MAIN INDICATIONS: MAIN INDICATIONS: PATENTCLEAR AIRWAY (ANAESTHESIA & ICU) PATENT CLEAR AIRWAY (ANAESTHESIA & ICU) CONTROLLED VENTILATION CONTROLLED VENTILATION DRUG ADMINISTRATION (O DRUG ADMINISTRATION (O2 2, INHALATIONAL ANAESTHESIA,….) , INHALATIONAL ANAESTHESIA,….) AIRWAY SUCTIONING AIRWAY SUCTIONING CUFFED ETT: PREVENT ASPIRATION, ENSURES EFFICIENT VENT. (WATER TIGHT- AIR TIGHT)
- 48. EQUIPMENT: • ENDOTRACHEAL TUBES( TYPES, SIZES,…) • LARYNGOSCOPES • MAGILL FORCEPS • AIRWAYS ( ORAL, NASAL, SIZES,…) • OTHERS ( TOPICAL ANALGESIA, SYRINGES, SUCTION, ADHESIVE TAPE,…..)
- 49. ENDOTRACHEAL INTUBATION TECHNIQUE: • PRE-OXYGENATION •30 SECONDS ONLY FOR ATTEMPT • INSERT TUBE THROUGH LARYNX UNDER DIRECT VISION • IF IN DOUBT OR DIFFICULTY, RE-OXYGENATE BEFORE FURTHER ATTEMPTS A PATIENT MAY BE HARMED BY FAILURE OF OXYGENATION, NOT FAILURE OF INTUBATION!
- 50. • OPTIMAL PATIENTPOSITION • USUALLY UNDER GENERAL ANESTHESIA (IV INDUCTION, MUSCLE RELAXATION & IPPV ) • OROTRACHEAL / NASOTRACHEAL • EXTUBATION
- 51. HEAD POSITIONING: HEADPOSITIONING: "SNIFFING THE MORNING AIR", "SNIFFING THE MORNING AIR", THE NECK THE NECK SLIGHTLY SLIGHTLY FLEXED FLEXED AND THE HEAD AND THE HEAD EXTENDED. EXTENDED. A PILLOW UNDER A PILLOW UNDER THE HEAD AND NECK BUT THE HEAD AND NECK BUT NOT NOT UNDER THE SHOULDERS. UNDER THE SHOULDERS. A STRAIGHT LINE OF VISION A STRAIGHT LINE OF VISION FROM THE MOUTH TO THE FROM THE MOUTH TO THE VOCAL CORDS VOCAL CORDS
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- 53. •ENDOTRACHEAL INTUBATION ENDOTRACHEAL INTUBATION LARYNGOSCOPYAND TUBE INSERTION
- 55. CONFIRMING CORRECT ETTPLACEMENT: CONFIRMING CORRECT ETT PLACEMENT: • DIRECT VISUALISATION AT LARYNGOSCOPY DIRECT VISUALISATION AT LARYNGOSCOPY • AUSCULTATION: AUSCULTATION: • - BILATERALLY, MID-AXILLARY LINE - BILATERALLY, MID-AXILLARY LINE • - OVER THE EPIGASTRIUM - OVER THE EPIGASTRIUM • SYMMETRICAL MOVEMENT OF THE CHEST SYMMETRICAL MOVEMENT OF THE CHEST • OESOPHAGEAL DETECTOR DEVICE OESOPHAGEAL DETECTOR DEVICE • CAPNOMETRY CAPNOMETRY
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- 57. •ENDOTRACHEAL INTUBATION Advantages Advantages • Ventilationwith Ventilation with up to 100% O up to 100% O2 2 • Isolates airway, Isolates airway, preventing preventing aspiration aspiration • Allows Airway Allows Airway aspiration aspiration •Alternative rout Alternative rout for drug for drug administration administration Limitations Limitations • Training & experience Training & experience • Failed insertion, Failed insertion, oesophageal placement oesophageal placement • Potential to worsen Potential to worsen cervical cord or head cervical cord or head injury injury
- 58. ENDOTRACHEAL INTUBATION: ENDOTRACHEAL INTUBATION: COMPLICATIONS COMPLICATIONS •TRAUMA, REFLEX DISTURBANCES • BRONCHIAL / ESOPHAGEAL INTUBATION • TUBE KINKING / OBSTRUCTION • LARYNGEAL SPASM, ASPIRATION OF SECRETIONS,… • HOARSENESS OF VOICE, SORE THROAT, GRANULOMA OF THE LARYNX,……
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- 60. Needle cricothyroidotomy Is thesimplest and fastest access This is not not a "real life" procedure
- 61. NEEDLE CRICOTHYROIDOTOMY INDICATION • FAILURETO PROVIDE AN AIRWAY BY ANY MEANS • (CICO SITUATION) COMPLICATIONS • MALPOSITION OF CANNULA • EMPHYSEMA • HAEMORRHAGE • OESOPHAGEAL PERFORATION • HYPOVENTILATION • BAROTRAUMA
- 62. • Loss ofa patent patient airway can lead to life- threatening hypoxia within two to three minutes. To sum up…
- 63. • Airway management(AWM) skills are very essential for all physicians dealing with anesthetized, unconscious, traumatized or critically ill patients.
- 64. He, who failsto prepare , prepares to failure ! (Knowledge, skills and facilities)