Airway Management PPT

In The Name Of God : 

In The Name Of God Airway Management

Introduction : 

Introduction Directed By: Behdad Bazargani M.D. Anesthesiologist Ali Shah Abbasi M.D. Anesthesiologist

CPR consists of: : 

CPR consists of: Airway Management Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) Advanced Trauma Life Support (ATLS) CPR in special situations Ethical Issues

History : 

History 1966 : National research council conference (generated standards). 2005 : American Heart Association (AHA).

Introduction : 

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 : 

Survival Highest survival rates and quality of survival are attained when: - BLS is initiated within 4 min - ACLS is initiated within 8 min

Management of CPR : 

Management of CPR It is a team effort. Coordination of the team is the responsibility of the team leader (Ideally Anesthesiologist). Responsibilities of the team leader: 1- Ensure the quality of BLS. 2- Facilitate early use of electrical defibrillation. 3- Direct and monitor the adequacy of drug therapy. 4- Ultimately, the team leader decide when CPR should cease.

Indications : 

Indications Unconscious (unresponsive) Abnormal breathing, although there may be brief irregular, gasping breaths Pulselessness or non effective circulation Traumatic patient (electrical, drawing, crash, car accident, …)

To handle a CPR : 

To handle a CPR Avoid agitation Have a good knowledge Have a good physical ability

What to do First? : 

What to do First?

New Developments : 

New Developments Elimination of lay rescuer assessment of signs of circulation before beginning chest compressions. Simplification of instructions for rescue breaths should be given over 1second with sufficient volume to achieve visible chest rise. Elimination of lay rescuer training in rescue breathing without chest compressions.

New Developments… : 

New Developments… Recommendation of a (universal) compression-to- ventilation ratio of 30:2 for single rescuers of victims of all ages (except newborn infants). Increased emphasis on the importance of chest compressions: rescuers will be taught to “push hard, push fast” (at a rate of 100 compressions per minute), allow complete chest recoil, and minimize interruptions in chest compressions.

New Developments… : 

New Developments… Recommendation for provision of about 5 cycles (or about 2 minutes) of CPR between rhythm checks during treatment of pulseless arrest. Rescuers should not check the rhythm or a pulse immediately after shock delivery—they should immediately resume CPR, beginning with chest compressions, and should check the rhythm after 5 cycles (or about 2 minutes) of CPR.

New Developments… : 

New Developments… Recommendation that all rescue efforts, including insertion of an advanced airway (eg, endotracheal tube, esophagealtracheal combitube [Combitube], or laryngeal mask airway [LMA]), administration of medications, and reassessment of the patient be performed in a way that minimizes interruption of chest compressions. Recommendation of only 1 shock followed immediately by CPR (beginning with chest compressions) instead of 3 stacked shocks for treatment of ventricular fibrillation/ pulseless ventricular tachycardia.

Slide 18: 

Thanks For Your Attention

Airway Management : 

Airway Management Directed By: Behdad Bazargani M.D. Anesthesiologist Ali Shah Abbasi M.D. Anesthesiologist

Conditions need Airway management : 

Conditions need Airway management General anesthesia Respiratory failure Airway obstruction CPR

Airway Anatomy : 

Airway Anatomy Nose Pharynx Larynx Trachea Nasopharynx Oropharynx

Airway Anatomy : 

Airway Anatomy

Airway Anatomy : 

Airway Anatomy

Emergency Airway Management Evaluation : 

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 : 

Techniques of Airway Management Non-invasive -Head positioning -Removal of foreign body -Suctioning -Mask ventilation Invasive -ETT -LMA -Combitube

Airway obstruction : 

Airway obstruction

Head tilt chin lift & Head tilt jaw trust : 

Head tilt chin lift & Head tilt jaw trust

Mask ventilation : 

Mask ventilation

One hand mask holding : 

One hand mask holding

Two hand mask holding : 

Two hand mask holding

Oral Airways : 

Oral Airways

Disposable Berman Airways : 

Disposable Berman Airways

Hudson Cath-Guide Airways : 

Hudson Cath-Guide Airways

Rusch Berman Airways : 

Rusch Berman Airways

Rusch Color Coded Guedel Airways : 

Rusch Color Coded Guedel Airways

Oral Airway : 

Oral Airway

Nasopharyngeal Airway : 

Nasopharyngeal Airway

Rusch Latex Free Nasopharyngeal Airway : 

Rusch Latex Free Nasopharyngeal Airway

Nasopharyngeal Airway : 

Nasopharyngeal Airway

Endotracheal Intubation : 

Endotracheal Intubation

Indications for endotracheal intubation : 

Indications for endotracheal intubation Provides relative protection against pulmonary aspiration. Maintains a patent conduit for respiratory gas exchange. Provides a means for coupling the lungs to mechanical ventilators. Establishes a route for clearance of secretions. Provides a route for drug administration.

Equipments : 

Equipments Laryngoscope Tubes Oxygen source Bag & Mask Suction Lubricant Forceps (Magill) Adhesive tape Stylet Syringe

Stainless Laryngoscope Blades : 

Stainless Laryngoscope Blades

Laryngoscope Blades : 

Laryngoscope Blades

Tracheal Tube : 

Tracheal Tube

Airway Anatomy : 

Airway Anatomy

Uncuffed Tracheal Tube : 

Uncuffed Tracheal Tube

Endotrol Tracheal Tube with Controllable Tip : 

Endotrol Tracheal Tube with Controllable Tip

EMT Emergency Medicine Cuffed Tube with Injection Port : 

EMT Emergency Medicine Cuffed Tube with Injection Port

ETT sizes : 

ETT sizes Male: No. 8 + 0.5 Female: No. 7 + 0.5 Children: No = + 4 (or 3, for cuffed) Age 4

ETT : sizes (pediartics) : 

ETT : sizes (pediartics)

ETT Depth of insertion : 

ETT Depth of insertion Depth(cm) = + 12 Male: 23 cm Female: 21 cm Age 2

ETT : Depth of insertion : 

ETT : Depth of insertion

Sniffing Position : 

Sniffing Position 35o 80o

Incorrect position : 

Incorrect position

Incorrect position : 

Incorrect position

Sniffing Position : 

Sniffing Position

Incorrect position : 

Incorrect position

Incorrect position… : 

Incorrect position…

laryngoscopy : 

laryngoscopy

laryngoscopy : 

laryngoscopy

laryngoscopy : 

laryngoscopy

Sniffing Position : 

Sniffing Position

Laryngeal Mask Airway : 

Laryngeal Mask Airway

Laryngeal Mask Airway : 

Laryngeal Mask Airway

Laryngeal Mask Airway : 

Laryngeal Mask Airway

Laryngeal Mask Airway : 

Laryngeal Mask Airway

LMA-Fastrach : 

LMA-Fastrach

LMA- Fastrach : 

LMA- Fastrach

LMA- Fastrach : 

LMA- Fastrach

LMA-Fastrach : 

LMA-Fastrach

Examples of clinical airway problems managed with the LMA : 

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 : 

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

Slide 86: 

THE LMA IS NOT DISPOSABLE

Advantages of Using the LMA : 

Advantages of Using the LMA leaves provider’s hands free patient can produce effective cough allows spontaneous ventilation even malpositioned can adequately ventilate

Disadvantages of LMA over the ETT : 

Disadvantages of LMA over the ETT Lower seal pressure Higher frequency of gastric insufflation Increased Aspiration risk

LMA Complications : 

LMA Complications Aspiration Coughing Sore Throat

Combitube : 

Combitube

Combitube… : 

Combitube…

Retrograde intubation : 

Retrograde intubation

Retrograde Intubation… : 

Retrograde Intubation…

Retrograde Intubation… : 

Retrograde Intubation…

Retrograde Intubation… : 

Retrograde Intubation…

Retrograde Intubation… : 

Retrograde Intubation…

Retrograde Intubation… : 

Retrograde Intubation…

Cricothyrotomy : 

Cricothyrotomy

Cricothyrotomy Devices : 

Cricothyrotomy Devices

Cricothyrotomy : 

Cricothyrotomy

Cricothyrotomy… : 

Cricothyrotomy… Placement of Needle

Cricothyrotomy… : 

Cricothyrotomy… Wire Guide and Catheter In Place

Cricothyrotomy… : 

Cricothyrotomy… Catheter, Dilator and Wire Guide In Place

Cricothyrotomy… : 

Cricothyrotomy…

Rusch QuickTrach : 

Rusch QuickTrach

Jet Ventilation : 

Jet Ventilation

Jet ventilation Catheter : 

Jet ventilation Catheter

Thank you : 

Thank you

Awake Intubation : 

Awake Intubation Directed By: Behdad Bazargani M.D. Anesthesiologist Ali Shah Abbasi M.D. Anesthesiologist

Indications : 

Indications Respiratory failure Decrease LOC Difficult airway

Respiratory failure… : 

Respiratory failure… Status Asthmaticus Status Epilepticus Pulmonary Edema Chest wall injuries Etc

GCS : 

GCS Motor: Category score Obeys 6 Localizes 5 Withdraws 4 Flexion 3 Extension 2 None 1

GCS : 

GCS Verbal response: Category score Oriented 5 Confused 4 Inappropriate words 3 Incomprehensible sounds 2 None 1

GCS : 

GCS Eye opening: Category score Spontaneously 4 To speech 3 To pain 2 None 1

Slide 115: 

GCS =or< 8 Intubation

Equipments : 

Equipments Drugs Ventilator Laryngoscope Tubes Oxygen source Bag & Mask Suction Lubricant Forceps (Magill) Adhesive tape Stylette Syringe

Drugs : 

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… : 

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… : 

Drugs… E- Beta-adrenergic blocking drugs: Esmolol (10 – 20 mg IV) F- Local anesthetics agents: Lidocaine ( 1 – 1.5 mg/Kg IV or aerosol anesthetic sprays) G- Nerve blocks…

IV Drugs for Endotracheal Intubation : 

IV Drugs for Endotracheal Intubation

Sellick’s maneuver : 

Sellick’s maneuver

Then… : 

Then… Ask for Ventilator

Slide 123: 

Thank You