Download MBBS Neuroanaesthesia PPT 2 Basic Airway Managment Lecture Notes

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? 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

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Basic Airway management

Inadequate

Cardiopulmonary

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Ventilation

Resuscitation

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Decrease

Respiratory

Airway obstruction

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Effort

Decrease Respiratory Effort

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Airway Obstruction

Intrinsic (ICH)

Unconsciousness; Foreign

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Extrinsic (opioids)

Body; Injury; Secretions

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Silent

Noisy

Difficult to assess

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Easier to detect

Rate, pattern and depth

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Accessory Muscle
Basic airway

management

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Children

Adult

Airway foreign bodies

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Emergency conditions

Potentially life-threatening causes

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? Foreign body

? Blunt or penetrating injury

? Epiglottitis

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? Upper airway burns

? Croup

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? Anaphylaxis

? Bacterial tracheitis

? Laryngotracheomalacia

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? Retropharyngeal abscess

? Hereditary angioedema

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? Peritonsillar abscess

? Vocal cord dysfunction

? Infectious mononucleosis

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? Laryngospasm
MILD OBSTRUCTION

Ability to speak

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Hoarse cry

Encourage continuing

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coughing

Forceful cough

Good air entry

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Stay and monitor

Inspiratory stridor

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Snoring (stertor)

Take steps if progress to

Minimal or no retractions

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severe obstruction

No nasal flaring or

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grunting

SEVERE OBSTRUCTION

Universal Choking sign

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Unable to speak or cry

Take steps to relive

Poor or no air entry

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obstruction: Abdominal

thrusts/ Chest thrusts/

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Retractions

Back thrusts

nasal flaring

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Prolonged inspiratory time

No Blind finger-sweeps

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Tachypnea

CPR when unconscious

Audible inspiratory stridor

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loss of consciousness
Management

? History and Examination

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? Radiological images and Endoscopy
? Positioning Manoeuvres
? Airway Adjuncts
? Patient position
? Breathing Techniques

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? Cervical fixation technique
WWW.SMSO.NET

Anatomic considerations in children

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? Prominent occiput
? Small mouth opening
? Large tongue, tonsils and adenoids
? Superior laryngeal position
? Weaker hyoepiglottic ligament

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? Large, floppy epiglottis
? Shorter trachea
? Anatomic subglottic narrowing
PHYSIOLOGIC CONSIDERATIONS

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? 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

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? Higher oxygen metabolism: (6 versus 3 mL/kg/min)
? Prone to respiratory fatigue: lower percentage of type 1 muscle

fibres

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? Higher vagal tone


Head Tilt & Chin Lift

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Head Tilt & Chin Lift
Jaw-thrust manoeuvre

Jaw-thrust manoeuvre in children
Oropharyngeal Airway by Arthur Guedel

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? Pushing the tongue posteriorly
? too small a device is ineffective
? too large a device can obstruct

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the larynx

? traumatizing the soft tissue
? in intact airway reflexes, induce

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vomiting
Nasopharyngeal Airway

Used when

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? Select NPAs based on length

? OPA insertion is difficult

? nostril to the earlobe or the

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angle of the jaw

? oral trauma
? clenched Jaw

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? Intracranial NPA placement

? semiconscious patient

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? long NPA may enter oesophagus

? intact airway reflexes

? Injury to the nasal mucosa

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Sniffing position

Recovery Position
Breathing Techniques: Bag Valve Mask

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? 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

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? Sizes: Infant , children and adult

Components
Complications

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? Stomach Inflation
? Overinflation more harmful

than hyperventilation

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? 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

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