In the resuscitation of any patient

management of airway is the first

priority
There is no point managing
breathing and circulation
problems if the patient does not
have a patent airway.

MANAGEMENT OF AIRWAY
PRIMARY ABCD SURVEY
Focus: Basic CPR and Defibrillation
Check responsiveness
Activate emergency response system
Call for defibrillator
A = Airway: open the airway
B = Breathing: check breathing, provide
positive-pressure ventilations
C = Circulation: check circulation,
give chest compressions
D = Defibrillation: assess for and shock
VF/pulseless VT

Clinical Signs of Airway Compromise
: Threatened Patency
Inspiratory stridor
Snoring ( pharyngeal obstruction )
Gurgling ( blood/ secretions )
Drooling ( epiglottitis )
Hoarseness ( laryngeal edema/ vocal cord
paralysis)
Paradoxical chest wall movement
Tracheal tug
Mass - abscess, hematoma, angioedema

MANUAL AIRWAY
MANAGEMENT MANEUVERS
Head-tilt/Chin lift
Jaw-thrust without head-tilt
Modified jaw-thrust
OROPHARYNGEAL AIRWAY
NASOPHARYNGEAL
AIRWAY
INSERTION TECHNIQUE
:
Oxygen delivered with a face mask at a rate of 10-15 L/min
Select the proper-sized mask; it should cover the mouth and nose
and fit snugly against the cheeks.
Place the patient in the sniffing position.
Place the mask over the patient's mouth and nose with the right
hand.
With the left hand, place the small and ring fingers under the
patient's mandible, and lift up to open the airway.
Grasp the mask with the thumb and index finger, and press it to the
patient's face while lifting the mandible with the ring and small
fingers.
Compress the bag with the right hand.
The chest should rise with each breath, and airflow should be
unimpeded.
BAG- MASK VENTILATION
Keyventilation volume: enough to
produce
obvious chest rise

1-Person:
difficult, less effective
2-Person:
easier, more effective
Orotracheal Intubation
Nasotracheal Intubation
Percutaneous Tracheostomy
Surgical Tracheostomy

EQUIPMENT FOR INTUBATION
Laryngoscope with
several blades
Tracheal tubes
Malleable stylet
10-mL syringe
Magill forceps
Water-soluble lubricant
Suction unit, catheters, and tubing

Extend-the-head-on-neck (look up): aligns axis A relative to B
Flex-the-neck-on-shoulders (look down): aligns axis B relative to C

A
B
C
A
B
C
Assessing oropharyngeal size:
Mallampatti Scale
Mallampati SR, et al. CJA 1985; 32: 429-32.
tongue
vallecula
Vocal
cords
Glottic opening
Arytenoid
cartilage
epiglottis
Esophageal-Tracheal
Combitube
A = esophageal obturator; ventilation into trachea through side openings = B
C = tracheal tube; ventilation through open end if proximal end inserted in
trachea
D = pharyngeal cuff; inflated through catheter = E
F = esophageal cuff; inflated through catheter = G
H = teeth marker; blindly insert Combitube until marker is at level of teeth

A
B
C
D
E
F
G
H
Laryngeal Mask Airway (LMA)
The LMA is an adjunctive airway that consists of a tube
with a cuffed mask-like projection at distal end.