2. Learning and Skills Objectives
• Describe the “airway hierarchy”
• Be able to use airway devices
• Understand the complications of these airway
devices
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5. Oxygen Delivering Devices
In breathing patients who can protect his airway,
conscious or unconscious
Nasal cannula Simple face mask
Venturi mask Mask with O2 reservoir 2010
ALS Subcommittee
7. Oropharyngeal or
Nasopharyngeal Airway
Only in unconscious patient to prevent the
tongue from falling back
Oropharyngeal airway Nasopharyngeal airway
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8. Oropharyngeal and
Nasopharyngeal Airway
in Correct Position
Oropharyngeal airway in Nasopharyngeal airway in
place in the mouth place in the nose
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13. Laryngeal Mask Airway (LMA)
The LMA - a SUPRAGLOTTIC airway that
consists of a tube with a cuffed mask-like
projection at distal end
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14. LMA - Indications
• When mask ventilation fails to achieve adequate
oxygenation
• As an adjunct to airway management by
personnel not skilled in tracheal intubation
• As an adjunct to airway management by
personnel skilled in tracheal intubation when
endotracheal intubation is difficult or not
successful ALS Subcommittee 2010
15. Insertion: Preparation
• Choose the appropriate size
• Recommended size guidelines:
– Size 1: < 5 kg
– Size 1.5: 5 - 10 kg
– Size 2: 10 - 20 kg
– Size 2.5: 20 - 30 kg
– Size 3: 30 - 50 kg
– Size 4: 50 – 70 kg
– Size 5: >70 kg
ALS Subcommittee 2010
19. CONTROL OF THE
AIRWAY WITH
ENDOTRACHEAL TUBE
IS USUALLY REGARDED AS THE
“GOLD STANDARD”
limited to trained and skilled personnel
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20. Endotracheal Intubation
Weigh benefit of intubation VS adverse effect of
interrupting chest compressions during
intubation
Intubation should be done by most experienced
person
Do not take longer than 30 seconds per attempt
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22. Aligning Axes of Upper Airway
Mouth
A
A B
B
C
C
Pharynx Trachea
Extend-the-head-on-neck (“look up”): aligns axis A relative to B
Flex-the-neck-on-shoulders (“look down”): aligns axis B relative to C
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23. Cricoid Pressure
Thyroid
Cartilage
Cricoid
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24. Visualization of Vocal Cords
Anatomy
Tongue
Vallecula
Epiglottis
Vocal
cord
Glottic Arytenoid
opening cartilage
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25. Endotracheal Intubation
Complications
• Hypoxia – the act of intubation is an hypoxic
event
• Trauma—teeth, lips, tongue, mucosa, vocal
cords, trachea
• Vomiting and aspiration
• Hypertension/hypotension and arrhythmias
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26. Confirmation of advanced
airway placement
• Colour
• Visible chest rise
• Vapour in ETT
• 5 points auscultation
• Capnography / CO2 detector devices
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27. THANK YOU
NATIONAL COMMITTEE ON RESUSCITATION TRAINING
SUBCOMMITEE FOR ADVANCED LIFE SUPPORT
Dr Tan Cheng Cheng
Dr Luah Lean Wah
Dr Ismail Tan bin Mohd Ali Tan
Dr Wan Nasrudin bin Wan Ismail
Dr Chong Yoon Sin
Dr Priya Gill
Dr Ridzuan bin Dato’ Mohd Isa
Dr Thohiroh binti Abdul Razak
Dr Adi bin Osman
ALS Subcommittee 2010