Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Neuroanaesthesia PPT 2 Basic Airway Managment Lecture Notes
Basic Airway Management
Learning Objectives
? Which conditions need Airway management
? How to Recognise Severity of problem
? Different approach of Management for adult and children
? Familiarization to techniques of basic airway management
? Assessing your Knowledge gain
Basic Airway management
Inadequate
Cardiopulmonary
Ventilation
Resuscitation
Decrease
Respiratory
Airway obstruction
Effort
Decrease Respiratory Effort
Airway Obstruction
Intrinsic (ICH)
Unconsciousness; Foreign
Extrinsic (opioids)
Body; Injury; Secretions
Silent
Noisy
Difficult to assess
Easier to detect
Rate, pattern and depth
Accessory Muscle
Basic airway
management
Children
Adult
Airway foreign bodies
Emergency conditions
Potentially life-threatening causes
? Foreign body
? Blunt or penetrating injury
? Epiglottitis
? Upper airway burns
? Croup
? Anaphylaxis
? Bacterial tracheitis
? Laryngotracheomalacia
? Retropharyngeal abscess
? Hereditary angioedema
? Peritonsillar abscess
? Vocal cord dysfunction
? Infectious mononucleosis
? Laryngospasm
MILD OBSTRUCTION
Ability to speak
Hoarse cry
Encourage continuing
coughing
Forceful cough
Good air entry
Stay and monitor
Inspiratory stridor
Snoring (stertor)
Take steps if progress to
Minimal or no retractions
severe obstruction
No nasal flaring or
grunting
SEVERE OBSTRUCTION
Universal Choking sign
Unable to speak or cry
Take steps to relive
Poor or no air entry
obstruction: Abdominal
thrusts/ Chest thrusts/
Retractions
Back thrusts
nasal flaring
Prolonged inspiratory time
No Blind finger-sweeps
Tachypnea
CPR when unconscious
Audible inspiratory stridor
loss of consciousness
Management
? History and Examination
? Radiological images and Endoscopy
? Positioning Manoeuvres
? Airway Adjuncts
? Patient position
? Breathing Techniques
? Cervical fixation technique
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Anatomic considerations in children
? Prominent occiput
? Small mouth opening
? Large tongue, tonsils and adenoids
? Superior laryngeal position
? Weaker hyoepiglottic ligament
? Large, floppy epiglottis
? Shorter trachea
? Anatomic subglottic narrowing
PHYSIOLOGIC CONSIDERATIONS
? Age-related high respiratory rate
? Periodic breathing and Apnoea
? Preferential nasal breathing
? Smaller tidal volumes relative to body size (6 to 8 mL/kg)
? Lower functional residual capacity
? Higher oxygen metabolism: (6 versus 3 mL/kg/min)
? Prone to respiratory fatigue: lower percentage of type 1 muscle
fibres
? Higher vagal tone
Head Tilt & Chin Lift
Head Tilt & Chin Lift
Jaw-thrust manoeuvre
Jaw-thrust manoeuvre in children
Oropharyngeal Airway by Arthur Guedel
? Pushing the tongue posteriorly
? too small a device is ineffective
? too large a device can obstruct
the larynx
? traumatizing the soft tissue
? in intact airway reflexes, induce
vomiting
Nasopharyngeal Airway
Used when
? Select NPAs based on length
? OPA insertion is difficult
? nostril to the earlobe or the
angle of the jaw
? oral trauma
? clenched Jaw
? Intracranial NPA placement
? semiconscious patient
? long NPA may enter oesophagus
? intact airway reflexes
? Injury to the nasal mucosa
Sniffing position
Recovery Position
Breathing Techniques: Bag Valve Mask
? Developed by Holger Hesse & Henning Ruber in 1953
? AMBU company: Artificial Manual Breathing Unit
? Manual Resuscitator or Self Inflating Bag
? Provides PPV in emergency or Temporary Ventilation
? Disposable or Reusable
? Sizes: Infant , children and adult
Components
Complications
? Stomach Inflation
? Overinflation more harmful
than hyperventilation
? tidal volumes 6 to7 mL/kg
? 10 breaths each minute
? Each breath over 1 second
? Lung Injury with ETT
Flow Volume Loops in Airway obstruction
This post was last modified on 07 April 2022