Airway Unswagati

8/11/2019 Airway Unswagati

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Airway and Breathing Management

Aris Sunaryo, dr., SpAn., M.Kes

Department of Anesthesiology & Intensive Therapy

Waled General Hospital

Cirebon


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Awake? /No

Breath ? /No

Airway management

Breath ?/No

Breathing Support 2x

Carotid Pulse /No

Circulation support


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Identify the clinical settingsin which airway compromiseis likely to occur.

Recognize the signs and

symptoms of airwayobstruction.

Describe the techniques toestablish and maintain apatent airway.

Discuss the importance ofadequate oxygenation andventilation in all phases ofairway management.

Objectives


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Airway Assessment

Patient is alert and oriented.

Patient is talking normally.

There is no evidence of injury to

the head or neck.

You have assessed andreassessed for deterioration.

How do I know the airway is adequate?


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Airway Assessment

Signs and symptoms of airway compromise (cont.)

Tachypnea Abnormal breathing pattern

Low oxygen saturation (late sign)


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Anatomi


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Anatomi


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Anatomi


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Airway Assessment

Impending Airway Obstruction


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Recognition of Airway obtruction;

Can not hear and feel of air flow at the mouthand nose for complete airway obstruction

When patients still breathing inspiratory

retraction of intercostal and supraclavicular

Partial airway obstruction : snoring, crowing,

gurgling, wheezing

Hypercarbia : somnolence

Hypoxemia : sympathetic stimulation


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Manual clearing of the airway:The crossed finger maneuver

Finger behind teeth manuever

Tongue jaw lift manuever

Clearing the airway by suction


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Technique for foreign body clearing

If the victim is conscious,

encourage to expel by coughing and spitting it out

Apply abdominal thrust s or back blows

If the victim is unconscious

Apply back blows or abdominal thrust in horizontal

position


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Airway Assessment

When to intervene when the airway is patent

Inability to protect the airway

Impending airway compromise Need for ventilation


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Gambar.Face Mask Dewasa Gambar.Face Mask Anak


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Gambar. cara satu tangan memegang face mask Gambar. jalan nafas yang sulit dapat digunakan

teknik dua tangan


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How do I manage the airway of a traum a patient?

Supplemental oxygen

Basic techniques

Basic adjuncts

Definitive airway

Cuffed tube in the trachea

Difficult airway adjuncts

Unexpected difficult airway

Predicted difficult airway

Airway Management

P i i i h i


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Positioning to open the airway

Head tilt

Neck lift

Chin lift

Jaw thrust

Open the airway using equipment

Oropharyngeal airway

Nasopharyngeal airway

Endotracheal intubation

Cricothyroidotomy and Tracheostomy


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Protect the cervical spine during airwaymanagement!

Airway Management

Caution


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Airway Management

Chin-li f t Maneuver

Basic Techniques


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H

Chin Lift Neck Lift


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Airway Management

Jaw-thrust Maneuver

Basic Techniques


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Airway Management

Oropharyngeal airway

Basic Adjuncts

Patients who can tolerate an oral airway will

usually need intubation.

Nasopharyngeal airway

Often well tolerated


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GambarA : Penempatan Oropharingeal Airway, B : Penempatan Nasopharingeal Airway


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Airway Management

I s this a diff icul t airway?

How would you manage this

patient?


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Airway Management

Preoxygenate Cricoid pressure

Sedate (midazolam) Paralytic (succinylcholine) Intubate Confirm (Auscultate, CO2) Release cricoid pressure and ventilate

Definitive Airway Easy


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Tabel.Variasi LMA dengan Perbedaan Volume Cuff yang Disediakan untuk Pasien yang

Berbeda Ukuran


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Tabel.Keuntungan Dan Kerugian Dari LMA Dibandingkan Dengan Face Mask Dan ETT


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usia Diameter internal (mm) Panjang (cm)

Bayi cukup bulan 3,5 12

Anak anak 4 + usia/4 14 + usia/2

Dewasa

Wanita 7.0-7,5 24

Laki-laki 7,5-9,0 24

Tabel.patokan ukuran ETT.


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Gambar. posisi aman dan intubasi dengan blade macinthos


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Gambar.sisi yang diauskultasi untuk suara nafas pada dada dan lambung.

Selama laringoskopi dan intubasiMalposisi

I t b i h


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Intubasi esophagus

Intubasi bronchial

Posisi cuff laryng

Trauma jalan nafas

Gigi rusak

Lacerelasi lidah, bibir dan mucosa

Dislokasi mandibula

Retropharingeal diseksiReflek fisoilogi

Hipoksia, hiperkarbi

Hipertensi, takikardi

Hipertensi intracranial

Hipertensi intraokuler

Laringospasme

Malfingsi pipa

Perporasi cuff

Bergesernya pipa

Malposisi

Unitentional ekstubasion

Intubasi bronkhial

Posisi cuff laringeal

Trauma jalan nafas

Inflamasi mucosa dan ulcerasi

Exkoreasi di hidung

Malfungsi pipaTerbakar

Obstruksi

Menyertai ekstubasi

Trauma jalan nafas

Edema dan stenosis

Serak

Malfungsi laring dan aspirasi

Laringospasme

Tekanan negatif edema paru


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Tumor

Higroma kistik

Hemangioma

HematomaInfeksi

Abses mandibula

Abses peritonsiler

Epiglotitis

Kelainan kongenital

Sindroma pierre robin

Sindroma treacher collin

Atresia laring

Sindrom goldenharDistosia craniofacial

Benda asing

Trauma

Fraktur laring

Fraktur mandibula atau maxilla

Inhalasi burn

Cedera servikal

Gemuk

Extensi leher yang tidak adekuatRhematoid artritis

Spondilitis

Halo traksi

Variasi anatomi

Mikrognathia

Prognathia

Lidah yang besar

Celah palatum

Leher pendek

Tabel. Kondisi yang Dihubungkan dengan Kesulitan Intubasi.


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Gambar. klaifikasi mallampati.


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Airway Management

I s this a diff icul t airway?

How would you manage this

patient?


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Airway Management

Get help

Be prepared

Consider rapid sequence intubation vs. awakeintubation

Maintain c-spine immobilization

Consider use of: Gum elastic bougie

LMA / LTA

Surgical airway

Other advanced airway techniques, eg, fiberopticintubation

Definitive Airway Difficult


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Airway Management

Surgical airway

Cricothyroidotomy

Needle

Definitive Airway

Surgical


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Airway Decision Scheme


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How do I know the tube is in the r ight place?

Visualize it going through

the cords Watch the chest

Auscultation

Pulse oximeter CO2 detector

Radiology

Airway Confirmation


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Summary

Suspect airway compromise in all injured patients.

Adjuncts for establishing a patent airway include:

Chin-lift and jaw-thrust maneuvers

Oropharyngeal and nasopharyngeal airways

Laryngeal mask airway

Multilumen esophageal airway

Gum elastic bougie device


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Summary

A definitive airway requires a tube placed in the

trachea (inflated cuff, oxygen, assisted ventilation,

airway secure).

Oxygenated inspired air is best provided via a tight-

fitting oxygen reservoir face mask with a flow rate of

greater than 11 L/min.


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Thank you

Documents

Airway Unswagati