1. Airway Management L.Dadák, ARK FNUSA

2. Maintaining airway Noninvasive Noninvasive airwayairway laryngeal masklaryngeal mask combitubecombitube invasive invasive OTI, NTIOTI, NTI coniotomyconiotomy tracheotomytracheotomy vocal cords

3. First Aid - repetition FBAOFBAO

4. First Aid - repetition

5. Monitoring of breathing Auscultation lung + neckAuscultation lung + neck SpO2SpO2 capnography / capnometrycapnography / capnometry (arterial) blood gasses = Astrup(arterial) blood gasses = Astrup

6. SpO2 > 90%

7. CO2

8. CO2

9. Kapnograf

10. Bag Mask ventilation I: apnea, respiratory failure positive pressure ventilation positive pressure ventilation Tidal Volume = 6ml/kg = movements of Chest f 10.. 30 /min 21.. 100% O2 1 hand: 4 hands

11. OroPharyngealAirway I: unconsciousness + airway obstruction with tongue Correct size OPA: distance angle of mouth --- ear Risk in mild unconsciousness: vomitus + aspiration

12. LM

13. LM placed against glottis (radix of tongue, recessus piriformis, esophageal superior sphincter) I: instead face mask, OTI, difficult airway KI: full stomach full stomach gastro-oesophageal reflux, gastro-oesophageal reflux, high inspiratory pressure high inspiratory pressure longer operation longer operation

14. Combitube emergency situations instead OTI emergency situations instead OTI I: difficult airway I: difficult airway KI: stenosing process in pharynx / trachea KI: stenosing process in pharynx / trachea

15. Tracheal intubation Def: Placing tube to trachea through mouth/nose and larynx. I: maintain open airway (GCS < 8) maintain open airway (GCS < 8) toilet (no cough) toilet (no cough) maintain ventilation (shock, hypoventilation) maintain ventilation (shock, hypoventilation) narrowest place in airway – vocal cords – subglotic space (<8let)

16. OTI, NTI - aids: laryngoscope laryngoscope Magill tongs Magill tongs tracheal tubes tracheal tubes syringe syringe lead lead

17. How to: prepare all aids, (ventilate) position of pat. LA, GA, coma direct laryngoscopy placing tube inflate cuff ensure position

19. crooked spoon - Macintosh crooked spoon - Macintosh straight spoon - Miller straight spoon - Miller Laryngoscope:

20. Laryngoscopic view: radix of tongue epiglottis vocal cords trachea

21. Always easy? (Cormac & Lehane)

22. Verify placing of the tube auscultation auscultation End tidal CO2 End tidal CO2 fibroscopic view fibroscopic view

23. Complications of TI - early: trauma of teeth, soft tissue trauma of teeth, soft tissue placed to esophagus / endobronchialy placed to esophagus / endobronchialy aspiration aspiration cardiovascular -  P,  f, arrhythmia cardiovascular -  P,  f, arrhythmia  ICP  ICP laryngospasmus, bronchospasmus laryngospasmus, bronchospasmus

24. Complication of TI - later: damage of vocal cords, trachea damage of vocal cords, trachea sinusitis, otitis, sinusitis, otitis, decubitus – lip, nose decubitus – lip, nose obturation of tracheal tube by secret, blood obturation of tracheal tube by secret, blood

25. How to do NTI: 1.LA anemisation of nose 2.tube through nose 3.placing tube under visual control CAVE: deviation of septum nasi

26. Check your neck Mallanpati Mallanpati 3-3-2 3-3-2

27. Coniotomy urgent access to airway urgent access to airway lig. cricothyreoideum (lig. conicum) lig. cricothyreoideum (lig. conicum)

30. Coniotomy First try to ventilate, OTI First try to ventilate, OTI find the ligament find the ligament DO it. DO it.

31. Tracheotomy surgical access to trachea surgical access to trachea punction TS punction TS I: maintain AW long time I: maintain AW long time artificial ventilation artificial ventilation limitation of dead space limitation of dead space