Airway Management

What should we know

about “airway management”?

• Airway anatomy and function

• Evaluation of airway
• Clinical management of the airway

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Airway Definition :
• Airway is defined as a passage through
which the air/ gas passes during respiration,
consisting of

• Nasal and oral cavities

• Pharynx
• Larynx
• Trachea
• Principle bronchi
Airway Assessment
 Look Colour
Respiratory distress
Conscious state
Chest movement
 Listen Breath sounds
 Feel Respiratory distress
Airway Assessment : Signs Of Obstruction

 Snoring or gurgling
 Stridor
 Agitation (hypoxia)
 Use of accessory muscles
 Paradoxical chest movement
 Cyanosis
 Airway Management

How to open the airway?

Non equipment: -Head tilt / chin lift / jaw thrust

With equipment: -Oral/nasopharyngeal airway

-Combitube
-Laryngeal mask airway (LMA) -
-Endotracheal intubation
-Cricothyrotomy
-Tracheostomy
Head tilt , Chin lift
Jaw thrust
Airway Management Adjuncts
Oropharyngeal airway

Nasopharyngeal airway

Supraglottic (Extra glottic)airway

Oropharyngeal Airway
It holds the tongue away from the posterior pharynx,
but does not isolate the trachea

Available in various sizes

Size is measured from the corner of the mouth to

angle of jaw

Risk of gag reflex stimulation and vomiting.

• The oral airway is inserted
with the curve towards the
side of the mouth

• Then rotated so that the

curve of the airway
matches the curve of the
tongue
Nasopharyngeal Airway
• Soft plastic or rubber tube that is designed to pass just inferior to the base of tongue

• Passed through one of the nares and can be used in patients with an intact gag
reflex

• CONTRAINDICATED in cases of suspected or possible basilar skull fracture

• Not recommended in coagulopathy, nasal sepsis and deformities.

• Measured from tip of the nose to the corner of the patients ear.
The nasal airway is lubricated
with a water soluble lubricant

The beveled tip is inserted

directed towards the septum,
with the airway directed
perpendicular to the face

If resistance is met, rotating

the airway may help or the
other nare may be used
Laryngeal Mask Airway
Life saving device in case of difficult intubation.

Sits over the glottic opening

Available in different sizes

Has a drain tube for gastric suctioning

With some versions anendotracheal tube may be

passed through to aid in intubation
Laryngeal Mask Airway
i-gel
Airway management Advanced techniques:

• Endotracheal intubation
• Cricothyroidotomy
• Tracheostomy
 Endotracheal intubation:
• Consider Endotracheal
intubation if :

Failure to maintain an
airway/ ventilation by other
means

 Risk of aspiration

 Control CO2 (eg head

injury)
 Oral Endotracheal tube size guideline
Age Int diameter Length
(mm) (cm)

Full term 3.5 12

Child 4 + Age/4 12+ Age/2

Adult

Female 7.0 –7.5 20-23

Male 7.5 –8.0 21-24

Optimum laryngeal view achieved with
the Macintosh laryngoscope. In this
figure the epiglottis has been allowed to
drop a little posteriorly to show the
laryngoscope in position in the vallecula.
Visual confirmation of tracheal intubation
with the straight laryngoscope
 Endotracheal Intubation
Signs of Tracheal Intubation

•Respiratory gas moisture disappearing on inhalation and reappearing on exhalation

•Chest rise & fall
•No gastric distention
•Breath sounds over chest wall
•No breath sounds over stomach
•ET visualized between vocal cords
•CO2 excretion waveform
•Fiberoptic visualization of cartilaginous rings of the trachea and tracheal carina
 Cricothyroidotomy

Used in emergencies to establish an airway if intubation failed.

Types :

Needle
Percutaneous
Surgical
Cricothyroidotomy / Tracheostomy
Needle Cricothyroidotomy
Percutaneous Cricothyroidotomy
Percutaneous Cricothyroidotomy
Tracheostomy
 Ventilation

• Mouth to Mouth ventilation

• Mouth to mask ventilation
• Bag mask ventilation
• Advanced ventilation
Mouth to mouth ventilation
Mouth to Mask ventilation
Bag Mask ventilation
Bag Mask ventilation
Advanced ventilation
 Remember
1. Cervical spine

2. Patients die from lack of

oxygen not lack of an ETT
GUM ELASTIC BOUGIE (GEB)

Helpful in patients in whom only epiglottis is visualized

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Fiberoptic bronchoscope

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Video Laryngoscope
THANKS