airway management and ventilation - … · d3 basic airway management and ventilation objectives...
TRANSCRIPT
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D1
AIRWAY MANAGEMENT AND VENTILATION
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D2
AIRWAY MANAGEMENT AND VENTILATION
• Basic airway management and ventilation
• The laryngeal mask airway and Combitube
• Advanced techniques of airway management
• Basic mechanical ventilation
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D3
Basic airway management and ventilation
Objectives • Causes of airway obstruction • Recognition of airway obstruction • Basic techniques for airway management • Simple airway adjuncts • Simple devices to ventilate the patient’s
lungs
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D4
Common causes of airway obstruction • Upper Airway
– tongue – soft tissue oedema, foreign material – blood, vomit
• Larynx – laryngospasm, foreign material
• Lower Airway – secretions, oedema, blood – bronchospasm – aspiration of gastric contents
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D5
Recognition of airway obstruction
• LOOK for chest/abdominal movement
• LISTEN at mouth and nose for breath sounds, snoring, gurgling • FEEL at mouth and nose for expired air
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D6
Opening the airway • Head tilt • Chin lift • Jaw thrust
• CAUTION! – cervical spine injury – But, death from hypoxia is more
common than from injury to the cervical spinal cord
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D7
Head Tilt and Chin Lift
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D8
Jaw Thrust
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D9
Suction
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D10
Simple airway adjuncts
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D11
Sizing an oropharyngeal airway
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D12
Oropharyngeal airway insertion
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D13
Nasopharyngeal airway insertion
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D14
Mouth to mask ventilation Advantages: • Avoids direct person to
person contact • Decreases potential for
cross infection • Allows oxygen enrichment
Limitations: • Maintenance of airtight seal • Gastric inflation
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D15
Bag-valve-mask, 2-person ventilation
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D16
Ventilation using self inflating bag Advantages
• Avoids direct person to person contact
• Allows oxygen supplementation – up to 85%
• Can be used with facemask, LMA, Combitube, tracheal tube
Limitations When used with a facemask:
• Risk of inadequate ventilation
• Risk of gastric inflation • Need two persons for
optimal use
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D17
The Laryngeal Mask Airway
and Combitube Objectives
To understand: • The role of the LMA and Combitube
during CPR
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D18
The Laryngeal Mask Airway Advantages
• Rapidly and easily inserted
• Variety of sizes • More efficient
ventilation than facemask
• Avoids the need for laryngoscopy
Limitations • No absolute
guarantee against aspiration
• Not suitable if very high inflation pressures needed
• Unable to aspirate airway
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D19
LMA Insertion
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D20
The Combitube Advantages
• Rapidly and easily inserted
• Avoids need for laryngoscopy
• Protects against aspiration
• Can be used if inflation pressures high
Limitations • Available in 2 sizes
only • Potential for ventilation
via wrong lumen • Damage to cuffs on
insertion • Trauma on insertion • Single use
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D21
Ventilation with the Combitube
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D22
Advanced techniques of airway
management Objectives
To understand: • The advantages and limitations of tracheal
intubation during CPR • The technique of tracheal intubation • Methods for confirming correct placement of
a tracheal tube • The role of needle cricothyroidotomy
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D23
Tracheal Intubation Advantages
• Allows ventilation with up to 100% O2
• Isolates airway, preventing aspiration
• Allows aspiration of the airway
• Alternative route for drug administration
Limitations • Training and
experience essential • Failed insertion,
oesophageal placement
• Potential to worsen cervical cord or head injury
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D24
Tracheal Intubation Attempting intubation: • Pre-oxygenate the patient • Allow 30 seconds for attempt • Insert tube through larynx under direct vision • If in doubt or difficulty, re-oxygenate before
further attempts Patients are harmed by failure of
oxygenation, not failure of intubation!
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D25
Insertion of Tracheal Tube
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D26
Confirming correct placement of a tracheal tube
• Direct visualisation at laryngoscopy • Auscultation:
– Bilaterally, mid-axillary line – Over the epigastrium
• Symmetrical movement of the chest during ventilation
• Oesophageal detector device • Capnometry
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D27
• Anteroposterior pressure on cricoid cartilage by an assistant to occlude the oesophagus against cervical vertebra
Cricoid Pressure
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D28
Cricoid Pressure Advantages
• Reduces risk of regurgitation and aspiration
• Useful during intubation, ventilation with facemask or LMA
Limitations • May make intubation
more difficult • May impair
ventilation via facemask , LMA
• Avoid if active vomiting
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D29
Needle Cricothyroidotomy Indication • Failure to provide an airway
by any other means Complications • Malposition of cannula
– Emphysema – Haemorrhage – Oesophageal perforation
• Hypoventilation • Barotrauma
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D30
Any Questions?