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Airway Management.pptx

  1. DEFINITION • Airway management is the evaluation, planning and use of medical procedures and devices for the purpose of maintaining or restoring ventilation of a patient
  2. AIRWAY MANAGEMENT • Optimal strategies aid in airway patency, oxygen delivery and carbon dioxide excretion • Can be classified into two : non invasive and invasive • Non-invasive includes passive oxygenation, bag valve mask ventilation, non-invasive positive pressure ventilation • Invasive includes supraglottic airways, endotracheal intubation and cricothyroidotomy
  3. AIRWAY OBSTRUCTION • Obstruction of airway is medical emergency • If untreated it may leads to a lower blood oxygen tension and risks hypoxic damage to brain, kidneys, liver or could be fatal.
  4. SIGNS OF AIRWAY OBSTRUCTION • Snoring • Gurgling sounds • Stridor • Pooling of secretions • Inability to swallow ~ loss of gag reflex • Skin colour - cyanosis • Breathing effort - use of accessory muscles • Respiratory rate - tachypnea • Altered mental status - anxiety, confusion, coma
  5. OPEN AIRWAY • Head tilt-chin lift • Jaw thrust
  6. Blood/secretion – suction/remove debris Floppy tongue – oropharyngeal airway Maxilo-facial injury – attempt reduction/ intubation/ cricothyrotomy Mechanical blockade – finger sweap and removal of object Partially obstructed airway – jaw trust/ chin- lift Perform a rapid clinical airway assessment which includes - the patient’s level of responsiveness, skin color, respiratory rate, and depth of respirations. Obtain oxygen saturation.
  7. NON-INVASIVE AIRWAY DEVICES 1. Oropharyngeal airway 2. Nasopharyngeal airway 3. Bag-valve mask
  8. 1. Oropharyngeal airway • A curved, rigid instrument used to prevent the base of tongue from occluding the hypopharynx • Indicatiosn for pstients without gag reflex • Appropriate size is measured from the tip of the mouth to the angle of mandible • To insert, place with the concave portion cephalad and rotate 180 degree once passing tongue • However the contraindications for this device is for the responsive patient/ has gag reflex. 2. Nasopharyngeal airway • A pliable device that is inserted into the nostril • Particularly useful in patients with an intact gag reflex/maxillofacial trauma • Measured from tip of nose to tragus of ear • To insert, lubricate, then place into the most patent nostril • For the contraindicatiosn is for the responsive patient, alleged MVA patient (suspected frature to the base of skull/ midface, and infant which is less than 1 y/o.
  9. BAG-VALVE MASK • Consist of a self-inflating bag coupled with a facemask and a valve to prevent inhalation • Typically used with supplemental oxygen, however can be used with room air • Adequate oxygenation and ventilation required airway patency and a good mask seal • Seal; can be a one or two person technique (subsequent slide)
  10. Allows room air to enter if fresh gas flow is inadequate and an outlet valve that allows O2 to flow out if pressure is excessive Prevents air from returning to reservoir bag Prevent too much pressure Prevent expired air from going back into the system When inadequate flow is given, acts as a source of air; from room O2
  11. 3 WAYS OF HOLDING BVM 1. 1 hand E-C clamp technique 2. 2 hands E-C clamp technique 3. 2 thumbs down technique
  12. DIFFICULT BVM • M – mask seal – trauma, beard • O – obesity • A – age >55 • N – no teeth • S – stiff lungs
  13. SUPRAGLOTTIC AIRWAY DEVICES • Consist of a single cuff inflated with 20- 30 cc of air • Technically easier to insert, minimal interruption in chest compression, useful when the vocal cord are not visualized during intubation • Complications included aspiration of gastric contents Device that is placed in the oropharynx allowing for oxygenation and ventilation without the visualized or surgical insertion of a tube into the trachea Examples : Laryngeal mask airway
  14. DIFFICULT LMA • R – restricted mouth opening • O – obesity, obstruction • D – distorted anatomy • S – stiff lungs or C-spine
  15. ENDOTRACHEAL TUBE • Maintain airway patency • Permits suctioning of airway secretions • Enables delivery of high concentration of oxygen • May protect the airway from aspiration
  16. OXYGEN THERAPY • Process of administration of O2 at concentrations greater than room air to prevent HYPOXIA / HYPOXEMIA ( low concentration oxygen in the blood). • O2 therapy may help you to get enough O2 supply. It’s use when low blood O2 is present and helps you to get enough O2 supply. • It can be administered in various way from a nasal cannula (nasal prong) to hyperbaric oxygen inside a close chamber.
  17. INDICATIONS FOR O2 THERAPY • Anoxia: No O2 availability in tissues • Hypoxia: Insufficient of O2 availability in tissue • Hypoxemia: Insufficient O2 in the blood • Severe trauma • Severe respiratory distress ( Acute asthma/ pneumonia)
  18. SIGNS & SYMPTOMS FOR O2 THERAPY • Tachypnea • Dyspnea • Lethargy • Cyanosis • Disorientation
  20. NASAL CANNULA • 2 prongs • Flow rate 1-6L/min • Supplies 21-44% O2 • Every 1L increase oxygen flow will increase FiO2 by 4% • Oxygen concentration depends on oxygen flow rate, pattern of ventilation, patient inspiratory flow rate
  21. SIMPLE FACE MASK • Fits loosely on face which allows room air to be inhaled • Flow rate 5-10L/min • Supplies 35-60% O2
  22. HIGH FLOW MASK • Addition of reservoir bag increase capacity of O2 reservoir by 600-1000ml • Rebreathing mask: Provides 70-80% O2 with flow rate 10- 15L/min • Non-rebreathing mask: Provides 95-100% O2 with flow rate 10-15L/min
  23. VENTURI MASK • Based on Bernoulli principle: O2 is passed through a narrow orifice and creates a high velocity stream of gas. • Gives desired concentration of O2 (24- 60%) • Usually used for COPD patient
  25. •An airway management technique that produces: •Inducing immediate unresponsiveness (induction agent) • Muscular relaxation (neuromuscular blocking agent) •In a non fasting patient to prevent aspiration •The fastest and most effective means of controlling the emergency airway Definition
  26. Inability to maintain patent airway/tone Upper airway swelling, facial/neck trauma, Poor GCS Ventilatory compromise Hypoventilation, large pneumothorax, flail chest, Severe COPD, status asthmaticus Failure to adequately oxygenate Severe hypoxemia, APO, PE, ARDS Anticipation of deteriorating course Severe haemorrhagic shock, ICB with poor GCS, Septic shock
  28. PREPARATION • Preparing of medical staff available and the patient. Make sure to inform the relatives about the procedure and get the consent. • Preparation of the equipment for intubation (MALES) M- Mask (Beg valve mask, margills forceps) A- Airway adjunct (Nasopharyngeal airway/ oropharyngeal airway) L- Laryngoscope set (Handle, blade size 2,3,4,5, lubricant gel) E- Endotracheal tubes (Sizes depend on patient) S- Stethocopes, suction, syringe, spatula)
  29. PRE- OXYGENATION • Bag for 3-5 minutes to get enough O2 for lungs to stand for intubation procedure using beg valve mask (BVM) • To increase physiological stores of oxygen in order to prolong the time to desaturation during a period of apnoea, usual following induction of anaesthesia Ideally 100% oxygen should be given at least 3mins before induction of anesthesia
  30. PRE- MEDICATION • Pre medication such as sedations, analgesics and muscle relaxant will be served to the patient. • Fentanyl 1.5- 3 mcg/kg iv to reduce symphathetic response of increased BP and heart rate • Lidocaine 1.5mg/kg iv to reduce bronchospasm and reduce raised intracranial pressure
  31. PARALYSIS WITH INDUCTION • Induction agent : • Midazolam : 0.1-0.3 mg/kg • Etomidate: 0.3 mg/kg • Ketamine: 1-2 mg/kg • Propofol: 1-2mg/kg • Paralytic drug • Succinylcholine 1-2 mg/kg iv • Rocuronium 0.6-1.2 mg/kg iv
  32. POSITIONING 1)The head should be extended on the neck (Sniffing position). 2)If cervical spine trauma is suspected, have an assistant provide in-line immobilization. 3)Optional: Sellick manoeuvre (cricoid pressure) to prevent passive regurgitation
  34. CONFIRMATION OF ETT PLACEMENT • Direct visualization • Vapor in the ET tube • Equal chest rise bilaterally • 5 point auscultation • Oxygen saturation improve and maintain • Capnography • X-Ray post intubation
  36. POST INTUBATION MANAGEMENT • Note depth of ETT • 20-21 cm in women, 22-23 cm in men • The teeth should be used as landmarks due to their fixed position • Secure the ETT – tape or tie the tube • Check cuff pressure (20-30 cm H2O) • Leaking due to inadequate cuff pressure can cause aspiration pneumonia • Too high a pressure can lead to necrosis, perforation and tracheomalacia due to weakening of the tracheal cartilage • Periodical check of cuff pressure because they tend to deflate within hours or with change of position
  37. • Cont • Start sedation • Midamorphine infusion • Midazolam 30 mg + Morphine 30 mg diluted to a total 30 ml 0.9 % Normal Saline run 2- 5 ml/ hour. • Propofol infusion 20-60 mcg/kg/minute. • Insert ryles tube • Head up 30 degrees • Chest X-ray. (To confirm placement)
  39. Q & A • What is the definition of airway management? • Name the maneuver that be use in for opening the airway. • How to ensure that we use the correct size of oropharyngeal airway and nasopharygeal airway?

Hinweis der Redaktion

  1. An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used to maintain or open a patient's airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the person from breathing. Indications for an NPA include relief of upper airway obstruction in awake, semicomatose, or lightly anesthetized patients; in patients who are not adequately treated with OPAs; in patients undergoing dental procedures or with oropharyngeal trauma; and in patients requiring oropharyngeal or laryngopharyngeal suctioning ...