Airway Management PDF

AIRWAY MANGEMENT DR/ Mohamed Hassan Basic Airway Management Opening Airway Oropharyngeal & Nasopharyngeal Airway Bag Mask Ventilation Basic Airway Management Opening the Airway Head tilt–chin lift Basic Airway Management Opening the Airway...

AIRWAY MANGEMENT DR/ Mohamed Hassan Basic Airway Management Opening Airway Oropharyngeal & Nasopharyngeal Airway Bag Mask Ventilation Basic Airway Management Opening the Airway Head tilt–chin lift Basic Airway Management Opening the Airway Triple airway maneuver Basic Airway Management Opening the Airway Modified Jaw Thrust in Trauma Basic Airway Management Oropharyngeal Airway Basic Airway Management Oropharyngeal Airway Basic Airway Management Sizing An Oropharyngeal Airway Basic Airway Management Oropharyngeal Airway Basic Airway Management Nasopharyngeal Airway Basic Airway Management Nasopharyngeal Airway Basic Airway Management Bag Mask Ventilation Crucial airway management skill. Takes practice to perform correctly. Gives time for well-planned approach to definitive airway management. 3 keys: 1.Patent airway 2.Good mask seal 3.Proper ventilation Basic Airway Management Bag Mask Ventilation Difficult Bag Mask Ventilation MOANS Mask seal: cant approximate mask Obesity: redundant tissues impede airflow Age >55: loss of elasticity tissues No teeth: mask doesn’t sit properly Stiff (lungs/body): need increased pressure Basic Airway Management Bag Mask Ventilation C&E Basic Airway Management Mouth-to-Mask Ventilation Basic Airway Management Mouth-to- Shield Ventilation Advanced Airway Management  Endotracheal Intubation  Supraglottic Devices  LMA  Intubating LMA  I-Gel  Combitube  Alternative Airway  Fiberoptic Intubation  Glidescopes  Retrograde Intubation  Blind Nasal  Surgical Airway  Tracheostomy  Cricothyrotomy  Jet Ventilation Advanced Airway Management  Endotracheal Intubation Steps & Confirmation RSI, BURP, Sellick’s maneuver Complications Failed intubation Common Mistakes Advanced Airway Management  Endotracheal Intubation Steps 7Ps: 1)Preparation (Patient, Equipment) 2)Pre-oxygenation 3)Positioning 4)Pretreatment 5)Paralysis 6)Placement 7)Post intubation management Advanced Airway Management  Endotracheal Intubation Steps 1)Preparation of the patient Cardiac monitoring IV access and patency ensured Briefly airway assessment (LEMON) Pre-oxygenation Advanced Airway Management  Endotracheal Intubation Steps 1)Preparation of the equipment Suction Oxygen Bag Valve Mask (BVM) device Airway adjuncts - appropriately sized oropharyngeal airways available – - appropriately sized LMA available Laryngoscope (appropriate blade, light source & spare handle) ETT – size, cuff checked, plus a size above and below Bougie Monitoring and EtCO2 ( mandatory ) Advanced Airway Management  Endotracheal Intubation Steps Direct Laryngoscopy Miller Macintosh Advanced Airway Management  Endotracheal Intubation Steps 1)Preparation of the equipment Tube Size Male: 8 + 0.5 …. Average depth of insertion 22-24 cm (lips) Female: 7 + 0.5 …. Average depth of insertion 20-22 cm (lips) Children: (AGE/4) + 4 (or 3, for cuffed) ….. Average depth of insertion 3x the diameter of the tube Advanced Airway Management  Endotracheal Intubation Steps  Advanced Airway Management  Endotracheal Intubation Steps Sniffing position. Advanced Airway Management  Endotracheal Intubation Steps Premedication Sedative-hypnotics: Sodium Thiopental & Propofol Benzodiazepines: Midazolam Opioids: Morphine, Fentanyl & Remifentanil Dissociative Anaesthesia: Ketamine Neuromuscular blocking drugs (NMBDs):  Depolarizing: Succinylcholine  Non Depolarizing: Pancuronium, atracurium & Cis-atracurium Advanced Airway Management  Endotracheal Intubation Steps Sniffing position. MILS in the neutral position if suspected C-spine injury Open mouth AND inspect oral cavity. Remove dentures or debris. Place laryngoscope with left hand into the right side of the patient’s mouth, sweeping the tongue to the left. Elevate the laryngoscope to lift the mandible without levering on the teeth. The end of the blade should rest in the epiglottic vallecula allowing direct visualization of the larynx. Advanced Airway Management  Endotracheal Intubation Steps Suction the airway as required. Introduce bougie gently through the cords – tracheal clicks and hold-up should be appreciable. Advance the endotracheal tube over the bougie until the cuff is seen to pass through the cords. Approximate ETT length at lips for women is 20 – 21 and men 22 – 24 centimeters. Remove bougie. Inflate cuff. Connect BVM and commence ventilation. Confirm tube placement. Advanced Airway Management  Endotracheal Intubation Steps BURP maneuver Advanced Airway Management  Endotracheal Intubation Sellick’s Maneuver (Cricoid Pressure) Advanced Airway Management  Endotracheal Intubation Confirmation Waveform Capnography  Confirm and document ETT Placement  Continuous monitoring of ETT position  Detect ETT displacement Advanced Airway Management  Endotracheal Intubation Confirmation Advanced Airway Management  Endotracheal Intubation Confirmation Advanced Airway Management  Endotracheal Intubation Confirmation Supporting Methods: Direct visualisation of ETT passing through the vocal cords(BEST). Auscultation in both axillae and over the stomach(Bilateral breath sounds + Absence of epigastric sounds) Chest rise Condensation in ETT Chest X ray Fiberoptic confirmation  Advanced Airway Management 3  Endotracheal Intubation Common Mistakes Confirmation 1 2 4 Advanced Airway Management  Endotracheal Intubation - Failed Intubation oCall for help, don’t panic oReassess airway, positioning oReassess equipment oTwo person ventilation oOther advanced airway oSurgical airway oCALL FOR HELP Advanced Airway Management  Supraglottic Devices : Laryngeal Mask Airway (LMA) Intubating Laryngeal Mask Airway (i-LMA) I-Gel Advanced Airway Management  Supraglottic Devices Laryngeal Mask Airway (LMA) Advanced Airway Management  Supraglottic Devices I-Gel Advanced Airway Management  Supraglottic Devices I-LMA Advanced Airway Management Flexible Fiberoptic Scope Advanced Airway Management Video Laryngoscope GlidoScope Difficult airway Vs Failed airway The difficult airway is something one anticipates. The failed airway is something one experiences. Definition of Difficult Airway: A clinical situation in which conventionally trained anesthesiologists experiences difficulty with mask ventilation, tracheal intubation or both Can’t intubate Can’t Ventilate (CICV) is the most dangerous CVCI syndrome can occur unexpectedly to even most expert Anesthesiologists and will occur in the career of every anesthesiologist Difficult Endotracheal Intubation : “Using conventional laryngoscopy, it requires more than three attempts or more than 10 min. for proper positioning of endotracheal tube” Remember : LEMON Difficult Mask Ventilation : : “The clinical situation where using 100% oxygen and bag/valve/mask ventilation, an unassisted anaesthesiologist is unable to maintain oxygen saturation greater than 90% in a person who was capable of doing so before intervention” Remember : MOANS