Airway Management

Objectives

Recognize signs of a threatened airway

Manual techniques for establishing an airway
Manual techniques of mask ventilation
without or with suspected cervical spine
injury
Preparation and perform endotracheal
intubation and phramacologic therapy
Be familiar with airway adjuncts (laryngeal
mask airway, combitube)

Introduction
ABC of resuscitation
Focus is to ensure the airway is open, assess
patient breathing and support gas exchange
Secondary goal is preservation of
cardiovascular stability and the prevention of
aspiration
Healthcare providers must be skilled in
manually supporting the airway and
providing the essential process of
oxygenation and ventilation

Assessment
First step : Assess airway patency and
spontaneous breathing. Look, listen and feel
for air movement.
Observe the level of consciousness and
determine if respiratory efforts are absent
proceed to manual support and assist
ventilation while preparing to establish the
airway
Identify injury (e.g possible cervical spine
fracture)
Observe chest expansion, to assess respiratory
muscle activity and adequate ventilation

Assessment
Observe for suprasternal, supraclavicular or
intercostal retraction, tracheal tug or nasal
flaring that represent respiratory distress
Auscultate over the neck and chest for breath
sounds. Complete airway obstruction if there
is chest movement but breath sound are
absent. Incomplete obstruction if we hear
snoring, stridor, gurgling or noisy breathing.
Assess the protective airway reflexes (cough
and gag). Absence of protective reflexes need
for airway support.

Oxygen supplementation
Nasal cannula O2 100% 0,5-5 lt/m (FiO2 0,400,50)
Venturi mask O2 100% 6lt/m
Aerosol face mask
Reservoar face mask (rebreathing or non
rebreathing

Airway obstruction
Airway obstruction :
The majority of preventable deaths
following trauma occur as a result of airway
obstruction.
Obstruction may occur at any point within
the airway, from the upper airways to the
bronchi deep within the chest.

Common causes of airway obstruction

Upper Airway
- tongue (due to unconsciousness)
- soft tissue swelling
- blood, vomit
- direct injury
Larynx (voice box)
- foreign material, direct injury, soft tissue swelling
Lower Airway
- secretions, oedema, blood
- bronchospasm
- aspiration of gastric contents

Recognition of airway
obstruction
LOOK for chest/abdominal movement
LISTEN at mouth and nose for breath sounds and
abnormal noises
FEEL at mouth and nose for expired air
Abnormal sounds in airway obstruction
Snoring - due to obstruction of upper airway by
the tongue
Gurgling - due to obstruction of upper airway by
liquids (blood, vomit)
Wheezing - due to narrowing of the lower airways
Complete airway obstruction is silent.

For pediatric patients

Common causes of airway obstruction is
upper airway infection (e.g viral croup,
bacterial tracheitis, epiglottitis)
Airway obstruction in semiconscious child is
posterior displacement of tongue and collapse
of hypopharynx
Infant until 6 month age is obligate nosebreather, suctioning the nares can be useful
in cleaning the airway.

Manual methods to establish an

airway

Initial step to assure a patent airway in a

spontaneously breathing patient without
possible injury to the cervical spine is Triple
airway maneuver : neck extension, elevation
of mandible (jaw thrust), mouth opening

Opening the airway

Manual in-line stabilisation of the c-spine
Head tilt (NOT if c-spine injury)
Chin lift with manual in-line stabilisation of the cspine
Jaw thrust with manual in-line stabilisation of the
c-spine
Suction with manual in-line stabilisation of the cspine

Mouth to mouth ventilation

Oral airways
Will stimulate vomiting and movement in
conscious or semi-conscious casualties
This may result in;
worsening airway problems
cervical spine compromise

Nasal airways
Will cause bleeding from the nose in a large
number of cases.
This will result in worsening airway problems so use
only as a last resort.

Manual Mask Ventilation

Indication :
- Patient is apneic
- Spontaneous tidal volume is inadequate
- Reduce the work of breating
- Hypoxemia due to poor spontaneous
ventilation

Manual Mask Ventilation

Single handed method, left hand hold the

mask placement, bag reservoir compressed by
right hand
Observe the chest expansion and auscultation
Listen for any gas leaks around the mask
If patient apneic ventilation is performed 1216 times per minute. If spontaneous breathing
ventilation synchronized with patient
inspiratory efforts
Oxygen 100% at flow rate 15 l/minute

Cricoid pressure

Manual Mask Ventilation

If no cervical spine injury, the operator can do
slight neck extension, mandibular elevation
and gentle downward pressure the mask on
the face
If cervical spine injury is suspected the
operator should not do neck extension, may
choose two handed for mask placement but
assure no neck movement

Endotracheal intubation

Indication :
- airway protection
- relief of obstruction
- mechanical ventilation & oxygen
therapy
- respiratory failure
- shock
- hyperventilation for intracranial
hypertension
- reducing work of breathing
- facilitation of suctioning/pulmonary toilet

Laryngeal Mask

Combitube

Thank you