Dr Abdulaziz Alrabiah,MD Emergency Medicine, Trauma & EMS airway equipments Dr Abdulaziz Alrabiah,MD Emergency Medicine, Trauma & EMS

Oraopharyngeal airway also know as “Guedel"

used for unconscious patients ( no gag reflex) Uses Lifts the tongue off the posterior pharyngeal wall to prevent airway obstruction bite block assist oropharyngeal suctioning helps manual ventilation ( bag valve mask ventilation) used for unconscious patients ( no gag reflex)

Descriptions Sizes: equal to length in cm colour coded bite portions can aid easy size identification (children – 00, 1, 2; adults – 4, 5, 6) sized by measuring from the centre of the mouth between the first incisors to the angle of the mandible

Methods of insertion / use Children – insert directly over the tongue ideally with aid of a tongue depressor (no twisting through 180 degrees) Adults – rotate 180 degrees from concave upwards position as it is inserted over the tongue Lubricant may aid insertion

complications gagging, vomiting and aspiration soft tissue trauma to the tongue, palate and pharynx biting down on the hard surface can injure the teeth

Nasopharyngeal airway Nasal Trumpet

uses Provide an airway in patients with an intact gag reflex semiconscious patients ( they have gag reflex) Facilitate suctioning in patients with a weak cough

descriptions Sized by measuring from patients nostril to the meatus of the ear described by internal diameter in mm (range from 2–9 mm in half sizes) commonly 6–7 mm in an adult female and 7–8 mm for an adult male

method of insertion pre-prepare nose with topical local anaesthetic/vasoconstrictor spray Apply lubricant then insert tube with concave side facing away from the nasal septum advance along the septum horizontally and rotated 90 degrees to lie in the nasopharynx place a safety pin over the end just behind the flange to prevent it advancing too far The tip should be seen behind the uvula

complications Epistaxis and aspiration ulceration insertion through the cribriform plate into the brain

LMA Laryngeal Mask Airway

overview LMA is an acronym for Laryngeal Mask Airway a type of extraglottic airway device aka supraglottic airway device (SAD)

uses rescue airway in a failed intubation facilitate blind insertion of bougie or ETT into trachea facilitate blind insertion of bronchscopic assisted airway control improve oxygenation as part of rapid sequence airway approach ventilation during elective anaesthesia to fasted patients with low risks of regurgitation

description

Intubating LMA with endotracheal tube (e.g. FastTrackTM) (disposable) types reusable (silicon) Intubating LMA with endotracheal tube (e.g. FastTrackTM) (disposable)

LMA with gastric suction channel (e.g. ProSealTM) (disposable) I-Gel

size 0 (infant) to 6 (large adult) size 3 (females) or 4 (males) commonly used in adults

method of insertion / use blindly inserted to form a low pressure seal over the laryngeal inlet sniffing position partially inflated cuff lubricate mask surface aperture facing towards laryngeal inlet or posteriorly with a 180 degrees twist once behind tongue inflate cuff with 20-40mL of ai

complications inability to achieve a seal and ventilate (can be assisted by deepening the level of anaesthesia, inserting under direct vision with a laryngoscope, partially inflating the cuff, flexing the lower spine with chin lift) regurgitation and aspiration gas insufflation partial airway obstruction (mask misplacement) shaft kinking malposition dislodgement laryngospasm cough trauma to the upper airway (e.g. bleeding, dislodgement of teeth)

ETT Endo-Tracheal Tube

uses securing of airway and provision of mechanical ventilation

Description

Method of insertion/use choose appropriate size for patient (the size refers to the internal diameter, ID) eg. adult female 7.5mm, adult male 8.5mm; but varies with the individual child less than 10 years old: size = age/4 + 4 check cuff integrity lubrication (if required) decide on an appropriate technique for intubation laryngoscopy (visualisation of the cords) placement of ETT through vocal cords until indicator mark just below cords inflation of cuff check: tube fogging, chest rising and falling, ETCO2

other features radio-opaque strip -> can be seen on CXR location above carina = 3cm

complications early: difficult/failed intubation trauma bleeding cuff perforation endobronchial intubation late: tracheal mucosal necrosis stenosis

Laryngoscope device used to visualise the vocal cords to facilitate intubation

use visualisation the vocal cords to allow insertion of an endotracheal tube also useful for insertion of a gastric tube or TOE probe by lifting the larynx forwards.

Description handle : contain batteries blade : has light

Handle Standard size handle

Blades various type Macintosh (commonest; blade attaches to handle at 90 degrees) Kessel (like the MacIntosh but the blade attaches at 110 degrees) McCoy (MacIntosh like blade with a moveable distal tip segment, flexed by a lever controlled by the thumb of the hand holding the handle to displace the larynx forwards) Magill (straight blade with U-shaped cross section) Miller and Wisconsin blades (straight blades with curved tips) Disposable metal and plastic blades available Right-handed blades available for left handed people ( not standard) size : 3 -4 for adult , children < 3

Macintosh kessel McCoy Miller

methods of insertion Position and preparation identify the epiglottis laryngeal exposure tube delivery

position and preparation procedure performer at head end of the patient patient position supine , neck straight patient should be no higher than the operator’s xiphoid process external auditory meatus at horizontal plane with sternal notch I.e. use pillow under shoulder personal protective equipment hold the laryngoscope with left hand enter from right mouth angle, lift the lounge and mandible to left and upward direction movement at operator’s shoulder not elbow or wrist

look for epiglottis

look for vocal cords ( laryngeal exposure)

pass the ETT

complications Soft tissue injury and upper airway haemorrhage dislodgement or chipping of teeth laryngospasm failure to perform proceudre light source failure

Bag-Valve Mask Bag-Valve-Mask (BVM) Self-inflating resuscitation systems (e.g. LaerdalTM, AmbuTM, Air VivaTM)

uses administration of high flow O2 provision of PEEP provision of controlled ventilation provision of augmentation of spontaneous ventilatio

description

method of insertion /use High flow oxygen (e.g. 12–15 L/min) is attached to the system and it is attached to a mask or tube appropriate mask size place over mouth and nose tight fit open airway using two handed thumbs down technique (with an assistant bagging) in preference to the less effective one- handed C-E grip (best if OPA and NPAs in situ too) the bag is used to deliver oxygen to a spontaneously breathing patient or the bag compressed to manually ventilate them via a mask or tube

complications easy to hyperventilate patients and limited ability to gauge tidal volumes unable to gauge lung compliance (cf. a ventilator or Water’s circuit) gastric distension aspiration claustrophobia exhaled secretions and moisture can result in exhalation valve dysfunction and increased resistance to expiration risk of barotrauma if pop off valve close as unable to feel lung compliance with self-inflating bags if high free gas flows are not used high FiO2 will not be achieved

Thank you Abdulaziz Alrabiah