Basic Airway management PDF

Basic Airway Management Dr / Mohammed Fawzy Tantawy MD, EgFEM Consultant of Emergency & Critical Care Medicine Lecturer at The Faculty of Medicine Menoufia University Lecture Statement The inadequate delivery of oxygenated blood to the b...

Basic Airway Management Dr / Mohammed Fawzy Tantawy MD, EgFEM Consultant of Emergency & Critical Care Medicine Lecturer at The Faculty of Medicine Menoufia University Lecture Statement The inadequate delivery of oxygenated blood to the brain and other vital organs is the quickest killer of critically ill patients so, airway and ventilation management is always the first priority during the management of all critically ill patients. Airway Assessment  The most important early assessment is to talk to the patient and stimulate a verbal response.  A positive, appropriate verbal response with a clear voice indicates:- Patent airway. Adequate ventilation. Sufficient brain perfusion. Airway Assessment You should be able to assess for not only a patent airway but also a protected airway. Patients with altered mental status are at particular risk of airway compromise and often require airway management. Recognition of Airway Obstruction For individuals who are not fully conscious, or when there is doubt about the patency of the airway, a look- listen-feel approach is recommended Recognition of Airway Obstruction  Look for:- 1. Vomitus or secretions 2. Facial bone fractures 3. Facial burns 4. Neck injuries or hematomas 5. Abnormal chest and abdominal movement 6. Increasing work of breathing (working accessory muscles) Recognition of Airway Obstruction  Lesten to:- 1. Snoring 2. Gurgling 3. Stridor 4. Hoarseness of voice Recognition of Airway Obstruction  Feel for the airflow at the mouth and nose with your cheeks. ***If there is a risk of airborne infection, avoid getting close to the patients. Basic Techniques for Opening Airway  Head tilt chin lift Basic Techniques for Opening Airway  Jaw thrust maneuver Basic Techniques for Opening Airway ***Avoid head tilting in polytraumatized patients In trauma situations we can use:- 1. Chin lift only (without head tilt). 2. Jaw thrust only (without head tilt). Basic Adjuncts for Opening Airway  Oropharyngeal airway Basic Adjuncts for Opening Airway Oropharyngeal airway is contraindicated in conscious patients with active gag reflex, because it will induce vomiting and aspiration Patients tolerating oropharyngeal airway are likely to require endotracheal intubation Basic Adjuncts for Opening Airway  Nasopharyngeal airway Basic Adjuncts for Opening Airway  Nasopharyngeal airway is better tolerated even in conscious patients  Nasopharyngeal airway is contraindicated in patients with suspected fracture skull base (potential cribriform plate fracture) Supraglottic Airway Devices  Laryngeal mask airway Supraglottic Airway Devices  i-gel supraglottic airway  Supraglottic Airway Devices  Supraglottic airway devices are generally easier to be inserted than endotracheal tubes.  Supraglottic airway devices are considered lifesaving alternatives in cases of:- 1. difficult endotracheal intubation. 2. failed endotracheal intubation. 3. lack of the skill of endotracheal intubation Definitive Airway Definition: Definitive airway is a tube inserted in the trachea with a cuff inflated below vocal cords. Types:- 1. Orotracheal tube. 2. Nasotracheal tube. 3. Surgical cricothyroidotomy. 4. Tracheostomy. Endotracheal tube  The endotracheal tube is considered the definitive airway device because it enters the larynx, passing through the vocal cords.  Most tubes have an inflatable cuff that forms a seal between the tube and the wall of the trachea.  This provides a higher degree of protection against aspiration Endotracheal tube Endotracheal tube Only properly trained personnel with a high level of skill and competence should perform endotracheal intubation.  Complications:- 1. Failure to intubate. 2. Esophageal intubation. 3. Right main bronchus intubation. 4. Dental trauma. 5. Laryngeal injury. 6. Tracheal injury. Management of Ventilation Ventilation is the movement of air between the environment and the lungs via inspiration and expiration. Ensuring a patent airway is an important step in providing oxygen to the patients, but it only benefits patients when ventilation is also adequate. Management of Ventilation  Potential causes of inadequate ventilation:- 1. Airway obstruction. 2. Central nervous system depression. 3. Chest trauma particularly with rib fractures. 4. Cervical spinal cord injury. 5. Patients known to have underlying chronic pulmonary diseases. Management of Ventilation  Objective signs of inadequate ventilation:- Altered mental status or obtunded behavior (lethargy). Shallow rapid breathing. Use of accessory muscles. Diminished chest expansion detected by inspection and palpation. Diminished breath sounds by auscultation. Low oxygen saturation.  Management of Ventilation  Improve your ability to recognize inadequate ventilation by:- 1. Always don’t forget to monitor the patient's respiratory rate and work of breathing. 2. Obtain arterial or venous blood gas sample. 3. Use capnography if available. Management of Ventilation  The most effective method to manage inadequate ventilation is to intubate the trachea and connect to mechanical ventilation.  Prior to intubation ventilatory assistance may be needed using the Bag-Mask ventilation technique. Management of Ventilation  The Bag-Valve-Mask device Management of Ventilation  Bag-Mask ventilation (single-person technique) Management of Ventilation  Bag-Mask ventilation (two-person technique)