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

2. Oraopharyngeal airway
also know as “Guedel"

3. 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)

4. 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

5. 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

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

7. Nasopharyngeal airway
Nasal Trumpet

8. 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

9. 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

10. 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

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

12. LMA
Laryngeal Mask Airway

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

14. 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

15. description

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

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

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

19. 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

20. 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)

21. ETT
Endo-Tracheal Tube

22. uses
securing of airway and provision of mechanical ventilation

23. Description

24. 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

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

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

27. Laryngoscope
device used to visualise the vocal cords to facilitate intubation

28. 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.

29. Description
handle : contain batteries
blade : has light

30. Handle
Standard size handle

31. 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

32. Macintosh
kessel
McCoy
Miller

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

34. 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

35. look for epiglottis

36. look for vocal cords ( laryngeal exposure)

37. pass the ETT

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

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

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

41. description

42. 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

43. 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

44. Thank you
Abdulaziz Alrabiah