Airway Year 4 tutorial A B C D E

Goals of airway management Relieve airway obstruction & so maintain ability to adequately ventilate Relieve airway obstruction & so maintain ability to adequately ventilate Prevent aspiration & it’s potential complications Prevent aspiration & it’s potential complications

Airway Mishaps Preventable deaths from airway problems result from: Preventable deaths from airway problems result from: Failure to recognise an obstructed airway Failure to recognise an obstructed airway Inability to establish a patent airway Inability to establish a patent airway Failure to recognise an incorrectly placed airway Failure to recognise an incorrectly placed airway Displacement of a previously established airway Displacement of a previously established airway

RECOGNITION OF AIRWAY OBSTRUCTION

Causes of Airway Obstruction EPISTAXIS ANAPHYLAXIS FACIAL / MADIBULAR FRACTURES REDUCED GCS LARYNGEAL FRACTURE NECK HAEMATOMA BURNS VOMIT

Types of obstructed airway Sudden or Progressive Sudden or Progressive Partial or complete Partial or complete Transient, recurrent or permanent Transient, recurrent or permanent

Recognition of Airway Obstruction Agitation / Want to sit up Agitation / Want to sit up Coughing/choking Coughing/choking Snoring Snoring Gurgling Gurgling Stridor Stridor Tracheal tug Tracheal tug See-saw chest/abdominal movement See-saw chest/abdominal movement Use of accessory muscles Use of accessory muscles Cyanosis Cyanosis COMPLETELY OBSTRUCTED AIRWAY IS SILENT

ESTABLISHING A PATENT AIRWAY

Basic Airway Manoeuvres ALWAYS REMEMBER THE BASICS ALWAYS REMEMBER THE BASICS These skills should be used prior to initiating any advanced airway technique These skills should be used prior to initiating any advanced airway technique Chin lift/ Jaw thrust Chin lift/ Jaw thrust (Head-tilt) (Head-tilt)

Give Oxygen 15 litres oxygen via non-rebreathe reservoir face mask initially 15 litres oxygen via non-rebreathe reservoir face mask initially Then titrate guided by oxygen saturations Then titrate guided by oxygen saturations

Airway Adjuncts Suction Suction

Airway adjuncts Oropharyngeal airway (Guedel) Oropharyngeal airway (Guedel)

Airway adjuncts Nasopharyngeal airway Nasopharyngeal airway

Advanced airway techniques Laryngeal Mask Airway: Laryngeal Mask Airway: inserted blindly into the pharynx, forming a low- pressure seal around the laryngeal inlet. inserted blindly into the pharynx, forming a low- pressure seal around the laryngeal inlet.

Advanced airway techniques Endotracheal Intubation (Definitive Airway) Endotracheal Intubation (Definitive Airway) “cuffed tube proven to be in the trachea connected to oxygen supply” “cuffed tube proven to be in the trachea connected to oxygen supply”

Advanced airway techniques Surgical airway - cricothyroidotomy Surgical airway - cricothyroidotomy

Indications for definite airway (Partially) obstructed airway unrelieved by other measures (Partially) obstructed airway unrelieved by other measures Obtunded (GCS <8) – prevent aspiration Obtunded (GCS <8) – prevent aspiration Predicted clinical course (eg swelling) Predicted clinical course (eg swelling)

RECOGNITION OF INCORRECTLY PLACED OR DISPLACED AIRWAY

After insertion of airway adjunct or secure airway.... Assess its effect - is the airway now patent? Assess its effect - is the airway now patent? Mask misting Mask misting Breaths heard / felt Breaths heard / felt Chest rising Chest rising Ability to bag ventilate Ability to bag ventilate Assess breathing Assess breathing Repeated reassessment of airway Repeated reassessment of airway

REMEMBER Preventable deaths from airway problems result from: Preventable deaths from airway problems result from: Failure to recognise an obstructed airway Failure to recognise an obstructed airway Inability to establish a patent airway Inability to establish a patent airway Failure to recognise an incorrectly placed airway Failure to recognise an incorrectly placed airway Displacement of a previously established airway Displacement of a previously established airway Airway requires immediate assessment and frequent re-assessment

Questions? ?

Summary Know how to recognise airway obstruction Know how to recognise airway obstruction Know how to establish a patent airway Know how to establish a patent airway Appreciate the importance of re-assessment of the airway Appreciate the importance of re-assessment of the airway