Special airways for Ventilation

Special Airways for Ventilation

• A quiz on airways is available in the learning management system (BB) after class.
• The quiz contains 17 questions and is worth 50 points.
• Students can use their notes and PowerPoints while answering the quiz.
• Questions appear in random order, and only one question at a time.
• Students cannot go back to previously answered questions.
• Each attempt allows 60 minutes, and students can take the quiz two times.
• The scores from both attempts are averaged for the final score.

Oropharyngeal Airway

• Indications: Relieve upper airway obstruction if other maneuvers fail, use as a bite block for intubated patients.
• Uses and precautions: Use in sedated or unconscious patients. Insert using scissors, crossing fingers. Remove if the patient gags or retches. Body fluid precautions.
• Size selection: Measure the airway from the center of the mouth to the angle of the jaw, corner of the mouth to the earlobe, or central incisors to the angle of the jaw.
• Important considerations: A too-large airway can push the epiglottis against the larynx, causing obstruction. A too-small airway may not clear the tongue, leading to obstruction.
• Correct placement: The distal tip of the oropharyngeal airway should rest at the base of the tongue.

Nasopharyngeal Airway

• Also known as: Nasal trumpet or nasal horn
• Indications: Facilitate ventilation, removal of secretions via nasotracheal suctioning.
• Uses and precautions: Inspect nares for obstruction, use local anesthetic spray, water-soluble lubricant on airway. Insert parallel to the nasal floor and position the distal end 1 cm from the epiglottis.
• Size selection: Size 6 for adult females, 7 for adult males. A too-short airway will not separate the soft palate from the posterior wall of the pharynx. A too-long airway may enter the larynx, causing reflexes or potentially obstruct the epiglottis-vallecula space.

Esophageal Obturator Airway (EOA)

• Mechanism: The EOA is inserted into the esophagus.
• Ventilation: Has an opening for manual ventilation, and small holes for directing air to the lungs.
• Aspiration prevention: A blind distal end, and cuff, prevent aspiration of stomach contents.

Esophageal Gastric Tube Airway (EGTA)

• Similarities to EOA: Similar to EOA, but with exceptions.
• Distal opening: Has an opening at the distal end for removal of gastric distention.
• Nasogastric port: Features a nasogastric port for gastric drainage.
• Ventilation mechanism: No ventilation holes. Ventilation is through the ventilation port via a mask and resuscitation bag.

Laryngeal Mask Airway (LMA)

• Design: Resembles a short endotracheal tube with a small, cushioned oblong-shaped mask on the distal end.
• Mechanism: Provides a seal over the larynx, with a standard cuff pressure of 60 cm H₂O.
• Indications: Used for airway management during CPR in profoundly unconscious patients without glossopharyngeal and laryngeal reflexes. Sometimes used as an elective airway in surgery.
• Contraindications: Does not protect the airway from aspiration, not for use in patients who haven't fasted or have hiatal hernia. Not for use in patients that are not profoundly unconscious, or have severe oropharyngeal trauma. Not for use with emergency resuscitation requiring drugs directly instilled into the airway (e.g., epinephrine).
• Size selection: Table 5-6 shows size selection based on patient group and maximum cuff volume.

Esophageal-Tracheal Combitube (ETC)

• Alternate names: Pharyngeal-tracheal lumen airway, esophageal-tracheal airway.
• Insertion: Can be inserted into the esophagus or trachea.
• Ventilation: Ventilation through lumen 1 when in esophagus, or lumen 2 when in the trachea.

Double-Lumen Endobronchial Tube (DLT)

• Alternative names: Double-lumen tracheobronchial tube.
• Uses: Used for lung isolation.
• Structure: Has 2 lumens, 2 cuffs and 2 pilot balloons. Left-sided DLT is more common. A right-sided DLT can cause RUL atelectasis if the bronchial cuff passes the RUL bronchus, as this bronchus is approximately 2 cm distal from the carina in adults.

Test your knowledge on various airway management techniques, including the use of oropharyngeal and nasopharyngeal airways. This quiz covers proper insertion methods, associated risks, and indications for different airway devices. Ideal for healthcare professionals seeking to enhance their skills in airway management.