Airway
Management
Introduction
Directed By:
Behdad Bazargani
M.D.
Anesthesiologist
1. Airway Management
2. Basic Life Support (BLS)
3. Advanced Cardiac Life Support (ACLS)
4. Advanced Trauma Life Support (ATLS)
5. CPR in special situations
6. Ethical Issues
History
1966 :
National research council conference
(generated standards).
2005 :
American Heart Association (AHA).
Introduction
CPR:
Systematic efforts for relief patient from
situation which threatened the life.
Effective CPR:
Artificial delivery of oxygenated blood to
systemic circulatory beds at rates
sufficient for preserving vital organ
function and physiologic substrates.
Survival
Highest survival rates and quality
of survival are attained when:
1. Unconscious (unresponsive)
2. Abnormal breathing, although there
may be brief irregular, gasping breaths
3. Pulselessness or non effective
circulation
4. Traumatic patient (electrical, drawing,
crash, car accident, )
To handle a CPR
1. Avoid agitation
2. Have a good knowledge
3. Have a good physical ability
What to
do First?
New Developments
General anesthesia
Respiratory failure
Airway obstruction
CPR
Airway Anatomy
Nose
1.Nasopharynx
Pharynx
2.Oropharynx
Larynx
Trachea
Airway Anatomy
Airway Anatomy
Emergency Airway Management
Evaluation
Level of consciousness
-Alert
-Responds to verbal stimuli
-Responds to painfull stimuli
-Unresponsive
Airway
-Patent
-Clear
Trauma to cervical spine
Techniques of Airway Management
Non-invasive
-Head positioning
-Removal of foreign body
-Suctioning
-Mask ventilation
Invasive
-ETT
-LMA
-Combitube
Airway obstruction
Head tilt chin lift & Head tilt jaw trust
Mask ventilation
One hand mask holding
Two hand mask holding
Oral Airways
Disposable Berman Airways
Hudson Cath-Guide Airways
Rusch Berman Airways
Rusch Color Coded Guedel Airways
Oral Airway
Nasopharyngeal Airway
Rusch Latex Free Nasopharyngeal
Airway
Nasopharyngeal Airway
Endotracheal
Intubation
Indications for
endotracheal intubation
1. Provides relative protection against
pulmonary aspiration.
2. Maintains a patent conduit for respiratory
gas exchange.
3. Provides a means for coupling the lungs to
mechanical ventilators.
4. Establishes a route for clearance of
secretions.
5. Provides a route for drug administration.
Equipments
Laryngoscope Lubricant
Tubes Forceps (Magill)
Oxygen source Adhesive tape
Bag & Mask Stylet
Suction Syringe
Stainless Laryngoscope Blades
Laryngoscope Blades
Tracheal Tube
Airway Anatomy
Uncuffed Tracheal Tube
Endotrol Tracheal Tube with
Controllable Tip
EMT Emergency Medicine Cuffed Tube
with Injection Port
ETT sizes
Age
Children: No = 4 + 4 (or 3, for cuffed)
ETT : sizes (pediartics)
ETT Depth of insertion
Age
Depth(cm) = + 12
2
Male: 23 cm
Female: 21 cm
ETT : Depth of insertion
Sniffing Position
35o
80o
Incorrect position
Incorrect position
Sniffing Position
Incorrect position
Incorrect position
laryngoscopy
laryngoscopy
laryngoscopy
Sniffing Position
Laryngeal Mask Airway
Laryngeal Mask Airway
Laryngeal Mask Airway
Laryngeal Mask Airway
LMA-Fastrach
LMA- Fastrach
LMA- Fastrach
LMA-Fastrach
Examples of clinical airway problems
managed with the LMA
Acromegaly
Ankilosing spondilitis
Rheumatoid arthritis
Facial burns
Failed airway in obstetric patients
Failed rigid broncoscopy
Fractured jaw
Temporomandibular joint disease
Limited mouth opening
Micrognathia
Neck contracture
Fix immobile cervical spine
Ossification of posterior longitudinal ligament
Cervical spinal tumor
Treacher Collins
Pierre Robin
Unstable neck
Characteristics of the LMA
Sizes Weight (Kg) Cuff Vol.(ml)
#1 <5 4
#1.5 5-10 7
#2 10-20 10
#2.5 20-30 14
#3 30< 20
#4 normal 30
#5 large 40
THE LMA IS NOT
DISPOSABLE
Advantages of Using the LMA
leaves providers hands free
patient can produce effective cough
allows spontaneous ventilation
even malpositioned can adequately
ventilate
Disadvantages of LMA over the ETT
Aspiration
Coughing
Sore Throat
Combitube
Combitube
Retrograde intubation
Retrograde Intubation
Retrograde Intubation
Retrograde Intubation
Retrograde Intubation
Retrograde Intubation
Cricothyrotomy
Cricothyrotomy Devices
Cricothyrotomy
Cricothyrotomy
Placement of
Needle
Cricothyrotomy
1. Respiratory failure
2. Decrease LOC
3. Difficult airway
Respiratory failure
Status Asthmaticus
Status Epilepticus
Pulmonary Edema
Chest wall injuries
Etc
GCS
Motor:
Category score
Obeys 6
Localizes 5
Withdraws 4
Flexion 3
Extension 2
None 1
GCS
Verbal response:
Category score
Oriented 5
Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1
GCS
Eye opening:
Category score
Spontaneously 4
To speech 3
To pain 2
None 1
GCS =or< 8
Intubation
Equipments
Laryngoscope
Tubes
Oxygen source
Bag & Mask Drugs
Suction
Lubricant
Ventilator
Forceps (Magill)
Adhesive tape
Stylette
Syringe
Drugs
A- Neuromuscular blocking drugs (NMBDs):
1- Depolarizing NMBDs-
Succinylcholine (1 1.5 mg/Kg IV)
2- Non Depolarizing NMBDs-
Vecuronium (0.25 mg/Kg IV)
Cis-atracurium (0.2 mg/Kg IV)
All patients requiring airway management
are probably at risk for aspiration of gastric
contents (Sellick maneuver).
Drugs
B- Sedative-hypnotics:
Sodium Thiopental
Propofol
C- Benzodiazepines:
Midazolam (0.5 1 mg IV)
Diazepam (2 mg IV)
D- Opioids:
Morphine, Fentanyl, Remifentanil
Drugs
Ask for
Ventilator
Thank You