AIRWAY MANAGEMENT AND VENTILATION

Assess Breathing Look for chest movementLook for chest movement Listen for breath soundsListen for breath sounds Feel for expired airFeel for expired air Assess for 10 seconds before deciding breathing is absentAssess for 10 seconds before deciding breathing is absent

Common causes of airway obstruction Upper AirwayUpper Airway –tongue –soft tissue oedema, foreign material –blood, vomit LarynxLarynx –laryngospasm, foreign material Lower AirwayLower Airway –secretions, oedema, blood –bronchospasm Aspiration of gastric contentsAspiration of gastric contents

Common causes of airway obstruction TONGUE DISPLACEMENT (cardiac arrest, coma, trauma) TOUNGE OEDEMA, OROPHARYNX OBSTRUCTION, LARYNGEAL SPASM (anaphylaxis, foreign body, irritants) LARYNGEAL, TRACHEAL OR BRONCHIAL OBSTRUCTION (foreign body) LARYNGEAL DAMAGE (trauma) LARYNGEAL OEDEMA (infection, anaphylaxis) BRONCHOSPASM (asthma, foreign body, irritants, anaphylaxis) PULMONARY OEDEMA (irritants, anaphylaxis, infection, drowning, brain stroke, shock)

Recognition of airway obstruction LOOK for chest/abdominal movementLOOK for chest/abdominal movement LISTEN at mouth and nose for breathLISTEN at mouth and nose for breath sounds, snoring, gurgling, crowing sounds, snoring, gurgling, crowing FEEL at mouth and nose for expired airFEEL at mouth and nose for expired air

Opening the airway Head tiltHead tilt Chin liftChin lift Jaw thrustJaw thrust CAUTION! – cervical spine injuryCAUTION! – cervical spine injury –But, death from hypoxia is more common than from injury to the cervical spinal cord

The Laryngeal Mask Airway Advantages Rapidly and easily insertedRapidly and easily inserted Variety of sizesVariety of sizes More efficient ventilation than facemaskMore efficient ventilation than facemask Avoids the need for laryngoscopyAvoids the need for laryngoscopy Limitations No absolute guarantee against aspirationNo absolute guarantee against aspiration Not suitable if very high inflation pressures neededNot suitable if very high inflation pressures needed Unable to aspirate airwayUnable to aspirate airway

The Combitube Advantages Rapidly and easily insertedRapidly and easily inserted Avoids need for laryngoscopyAvoids need for laryngoscopy Protects against aspirationProtects against aspiration Can be used if inflation pressures highCan be used if inflation pressures high Limitations Available in 2 sizes onlyAvailable in 2 sizes only Potential for ventilation via wrong lumenPotential for ventilation via wrong lumen Damage to cuffs on insertionDamage to cuffs on insertion Trauma on insertionTrauma on insertion Single useSingle use

Tracheal Intubation Advantages Allows ventilation with up to 100% O 2Allows ventilation with up to 100% O 2 Isolates airway, preventing aspirationIsolates airway, preventing aspiration Allows aspiration of the airwayAllows aspiration of the airway Alternative route for drug administrationAlternative route for drug administrationLimitations Training and experience essentialTraining and experience essential Failed insertion, oesophageal placementFailed insertion, oesophageal placement Potential to worsen cervical cord or head injuryPotential to worsen cervical cord or head injury

Tracheal Intubation Attempting intubation: Pre-oxygenate the patientPre-oxygenate the patient Allow 30 seconds only for attemptAllow 30 seconds only for attempt Insert tube through larynx under direct visionInsert tube through larynx under direct vision If in doubt or difficulty, re-oxygenate before further attemptsIf in doubt or difficulty, re-oxygenate before further attempts Patients are harmed by failure of oxygenation, not failure of intubation!

Confirming correct placement of a tracheal tube Direct visualisation at laryngoscopyDirect visualisation at laryngoscopy Auscultation:Auscultation: –Bilaterally, mid-axillary line –Over the epigastrium Symmetrical movement of the chest during ventilationSymmetrical movement of the chest during ventilation Oesophageal detector deviceOesophageal detector device CapnometryCapnometry

Needle Cricothyroidotomy Indication Failure to ventilate an apnoeic patient with a bag-valve- facemask, or to pass a tracheal tube or another airway deviceFailure to ventilate an apnoeic patient with a bag-valve- facemask, or to pass a tracheal tube or another airway deviceComplications Malposition of cannulaMalposition of cannula –Emphysema –Haemorrhage –Oesophageal perforation HypoventilationHypoventilation BarotraumaBarotrauma