1. Airway and Ventilation

2. Terms Respiration: breathing (External and internal)
Ventilation: breathing in of air or oxygen or providing breaths artificially.
Respiratory distress: increased work of breathing; sensation of shortness of breath
Respiratory failure: reduction of breathing to the point where oxygen intake is not sufficient to support life.
Respiratory arrest: stopping breathing completely.
Artificial Ventilation: forcing air or oxygen into the lungs when the patient has stopped breathing or has inadequate breathing.

3. Review of Anatomy & Physiology
Nose
Mouth
Pharynx
Larynx
Trachea
Bronchi
Bronchioles
Alveoli
Lungs
Diaphragm

4. Airway Control Manual cleaning of the airway Manual maneuvers
Jaw thrust
Chin lift
Suctioning

5. Basic Adjuncts – Oropharyngeal Airway
Indications:
Patient who is unable to maintain his airway
To prevent intubated patient from biting ETT.
Contraindications:
Conscious or semiconscious patient.
Complications:
Gagging and vomiting
Laryngeal spasm in conscious patient

6. Basic Adjuncts – Nasopharyngeal Airway
Indications:
Patient who is unable to maintain his airway
Contraindications:
No need for airway adjunct.
Complications:
Bleeding caused by insertion

7. Endotracheal Intubation
It is the preferred method of airway control
Isolated the airway
Allows for ventilation with 100 % oxygen
Eliminates the need to maintain an adequate mask to face seal
Decreases the risk of aspiration
Facilitates deep tracheal suctioning
Prevents gastric inflation
provides an additional route for drug administration

8. Endotracheal Intubation
Indications:
Patient who is unable to protect his airway
Patient with oxygenation problem requiring high concentrations of oxygen
Patient with ventilatory impairment requiring assisted ventilation
Contraindications:
Lack of training in technique
Lack of proper indications

9. Endotracheal Intubation
Complications:
Hypoxemia from prolonged intubation attempts
Trauma to the airway with resultant hemorrhage
Right main stem bronchus intubation
Esophageal intubation
Vomiting leading to aspiration
Loose or broken teeth
Injury to the vocal cords
Conversion of cervical spine injury to one with neurological deficit

10. Endotracheal Intubation
Verification of ETT placement:
Direct visualization of ETT passing through vocal cords
Presence of bilateral breath sounds and absence of air sounds over epigastrium
Visualization of chest rising and falling during ventilation
Fogging in ETT on expiration

11. Endotracheal Intubation
Verification of ETT placement adjunct devices:
Esophageal detector devices
Colorimetric Co2 detector
End-tidal Co2 monitoring (capnography)
Pulse oximetry

12. Larngeal Mask Airway It is designed for blind insertion
Can be reused multiple times
Disposable ones are now available
It is available in a range of sizes

13. Larngeal Mask Airway Indications: Contraindications: Complications:
When unable to perform ET intubation and the patient cannot be ventilated with BVM
Contraindications:
When ET intubation can be performed
Insufficient training
Complications:
Aspiration
Laryngiospasm

14. Surgical Cricothyrotomy
Indications:
Massive mid-face trauma precluding the use of BVM device.
Inability to control the airway less invasive maneuvers.
Ongoing tracheo-broncheal hemorrhage

15. Surgical Cricothyrotomy
Contraindications:
Any patient who can be safely intubated.
Patients with laryngotracheal injuries
Children under 10 years of age
Patients with acute laryngeal disease of traumatic or infectious origin
Insufficient training

16. Surgical Cricothyrotomy
Complications:
Prolonged procedure time
Hemorrhage
Aspiration
Misplacement or false passage of ETT
Injury to the neck structures or vessels
Perforation of the esophagus

17. Ventilatory Devices and Oxygen Concentration Without Supplemental Oxygen
Flow (L/Min)
Oxygen Concentration
Mouth to mouth NA
16 %
Mouth to mask
Bag-valve-mask
21 %

18. Ventilatory Devices and Oxygen Concentration With Supplemental Oxygen
Flow (L/Min)
Oxygen Concentration
Nasal Cannula
1 – 6
24 – 45 %
Mouth to mask 10
50 %
Simple face mask
8 – 10
40 – 60 %
BVM without reservoir
BVM with reservoir
10 – 15
90 – 100 %
Nonrebreathing mask with reservoir
Ventilator NA
21 – 100 %