Outline

Airway anatomy

Positioning

Airway adjuncts

Indication for intubation

Difficult airway management

Conclusion

Upper airway

Lower airway

Basic airway management

Assess for Airway Obstruction!
Difficulty breathing
Patient conduct (anxious, combative)
Abnormal sounds

Improve/Establish Airway Through Maneuvers

Chin lift
Jaw thrust

Remove Debris/Suction
Airway Adjuncts:
Nasal airway
Oral airway
Others

Opening the Airway

Head tilt-chin lift
Nontrauma patients,

medical patients

Jaw-thrust
Suspected spinal

injury

Airway instruments
Face mask

Face mask
Appropriate size: cover from the bridge of the
nose to chin
To get a tight seal: EC-clamp technique
The thumb and index finger hold the mask firmly over

the nose and chin (forming a C)

The third through fifth fingers firmly grasp the bony
mandible (forming an E)
sniffing position

Sniffing position

Laryngoscope

Oral airway
Keep the tongue from
falling back
Unresponsive patient

with no gag reflex

Corner of patients
mouth to the tragus

Oral airway; importance of proper size

Nasopharyngeal airway
Inserted into patient's
nostrils
Tip of patients nose
to the earlobe

Nasopharyngeal airway
Avoided in patients with:
evidence of fracture of middle third of face.
Base of skull fracture.

vascular abnormalities of nose.

bleeding disorders.
Nasal polyps.

Endotracheal tube
PVC
Choose appropriate size
Male : 7.5 8.0 (ID)

Female : 7.0 7.5

Pediatric : age/4 + 4

Intubating Stylet

Indications for intubation

Failure to oxygenate
Failure to remove CO2
Neuromuscular weakness
CNS failure
Cardiovascular failure

Steps to control airway

Pre-Intubation

-Prepare equipment
-Pre-oxygenate

Steps to control airway

Orotracheal Intubation Procedure

Sweep
Left and
Look

Steps to control airway

Find Your Landmarks

Backward, Upward, Right Pressure (B.U.R.P.)

Steps to control airway

Find Your Landmarks

Steps to control airway

Find Your Landmarks

It may not be perfect!

Steps to control airway

Find Your Landmarks

Steps to control airway

Readjusting with Cricoid Pressure

Confirm the airway

Intubation Confirmation
Good, Better, Best

Direct
Visualization

Lung Sounds

Tube
Condensation

ETCO2 (monitor)

Lung expansion

Secure the airway

Secure Your Tube

Good, Better, Best
Tape

Improvised devices
Immobilization

Steps to control airway

Common Mistakes
Making a difficult intubation more difficult

Rushing
Poor equipment preparation

Suction (lack there of)

Other options

Blind nasal
Fibreoptic intubation
Retrograde intubation
Trach light
Cook airway / Bougie
LMA / Combitube / Laryngeal tube
Tracheostomy

Helpful adjuncts

Gum
Elastic
Bougie

Helpful adjuncts
Laryngeal Mask Airway

Developed in 1981 at the Royal London

Hospital By Dr Archie Brain

Helpful adjuncts
Laryngeal Mask Airway

Indications:
-When definitive airway management
cannot be obtained. (ETT)
Not a substitute for definitive airway
management

Helpful adjuncts
Laryngeal Mask Airway

Contraindication/Limitations:
-Obesity
-Non-secure

-Size based

Helpful adjuncts
Laryngeal Mask Airway
Weight Based Sizing
<5kg = Size 1
5-10 kg = Size 2
20-30 kg = Size 2.5
Small Adult= Size 3
Average Adult = Size 4
Large Adult = Size 5

Helpful adjuncts
Laryngeal Mask Airway

Average Adult Woman = 4

Average Adult Male = 5

*If in doubt, check the LMA

Helpful adjuncts
Laryngeal Mask Airway
Procedure:
-Pre oxygenate
-Check cuff

-Lubricate posterior cuff

-Head in neutral or slightly flexed position
-Insert following hard palate (use index finger to guide)
-Stop when met with resistance
-Let go and inflate cuff
-Confirm and secure

Helpful adjuncts
Laryngeal Mask Airway
Air volume is variable depending on cuff size
and individual patient anatomy
General Guideline:
Size 1 = 4 ml
Size 2 = 10 ml
Size 2.5 = 14 ml
Size 3 = 20 ml
Size 4 = 30 ml
Size 5 = 40 ml

Helpful adjuncts
Laryngeal Mask Airway
Common Problems:
-Failure to seat properly
-Sizing difficulties
-Aspiration

Helpful adjuncts
Dual Lumen Airway

(Combitube)

Helpful adjuncts
Dual Lumen Airway

Indications:
-When definitive airway management
cannot be obtained. (ETT)
Not a substitute for definitive airway
management

Helpful adjuncts
Dual Lumen Airway
Contraindications/Limitations:
-No pediatrics
-Pathological esophageal disease
-Non-secure airway
-Latex sensitivity

-Toxic or Caustic Ingestions

Helpful adjuncts
Dual Lumen Airway
Procedure:
-Pre oxygenate

-Check equipment.
-Head in neutral position

-Insert until to guide lines

Helpful adjuncts
Dual Lumen Airway
Procedure:
Inflate Pharyngeal cuff
(blue) with 85-100cc of
air
Inflate tracheal cuff
(white) with 10-15cc of
air

Helpful adjuncts
Dual Lumen Airway
-Ventilate port 1 (longer, blue tube, #1).
If no lung sounds, switch ports
-Ventilate port 2 (shorter, white tube, #2)
*You will be either in the esophagus or the trachea

42

Helpful adjuncts
Lighted Stylette

AIRWAY

Conclusion
Always oxygenate patient before and after
intubation.
Do not attempt intubation unless you are

totally skilled, rather perform bag-valvemask ventilation.

Always monitor the Spo2 readings.
Always reconfirm tube placement from time
to time.