Anesthesia and critical care

2. Objectives
Airway obstruction
Basic

3. Critically ill approach
Airway
Breathing
Circulation
Disability
Exposure

4. Causes of airway obstruction
CNS depression
Blood
Vomit

5. Causes of airway obstruction
Foreign body

6. Causes of airway obstruction
Trauma

7. Causes of airway obstruction
Infection
Inflammation
Laryngospasm
Bronchospasm

9. Recognition
Talking
Difficulty breathing, distressed, choking
Shortness of breath
Noisy breathing
– Stridor, wheeze, gurgling
See-saw respiratory pattern, accessory muscles

10. Simple airway maneuvers
Head Tilt-Chin Lift:
Be confident there is no risk of injury to the c-
spine
One hand press forehead to extend neck
The volar surfaces of the tips of the index and
middle finger are used to elevate the mandible
which will lift the tongue from the posterior
pharynx.

14. Jaw thrust

15. Jaw thrust

16. Airway adjuncts
Prevent the tongue from occluding the airway and
thereby provide an open conduit for air to pass
Will not protect the trachea from aspiration of
secretions or stomach contents

17. Oropharyngeal airway
Create an open conduit through the mouth and
posterior pharynx
Different sizes

18. Sizing
Hard to hard

19. Placement

20. Nasopharyngeal airway
Firm rubber or plastic hollow tube that is passed
through the nose into the posterior pharynx.
When the use of an oropharyngeal airway is
difficult.

21. Sizing
Firm to firm

22. Placement
Lubrication

28. One person technique
Two persons technique
FiO2
Reservoir bag
For how long?

29. Laryngeal Mask Airway LMA

30. LMA
Provides an oval seal around the larynx
Lies at crossroads of digestive and respiratory
tract

31. Indications
Situations involving a difficult mask (BVM)
Back-up device where ETT not successful.
• Second-last-ditch airway where a surgical
airway is the only remaining option.

32. Steps
• Step 1: Size selection
• Step 2: Check cuff integrity
• Step 3: deflation of cuff on hard surface
• Step 4: Lubrication of the LMA
• Step 5: Position the Airway

33. Size

35. Endotracheal intubation

36. Ventilate patient
Position head and neck
“Sniffing position".
Pillow or folded towel under patient occiput
Lower part of the cervical spine flexed, and the
atlanto-occipital joint extended
Aligns the axes of the mouth, pharynx and
trachea