Owymardyan Y Manafe

1015018
Juni Royntan T 1015070

ANATOMY OF THE RESPIRATORY SYSTEM

Respiration

VENTILATION

WHAT HAPPENED DURING

VENTILATION

DEAD SPACE

ADEQUACY OF THE AIRWAY

Patency
Protective reflexes
Inspired oxygen concentration
Respiratory drive

PROBLEM RECOGNITION
Type of Trauma

Head Trauma
Maxillofacial Trauma
Neck Trauma
Laryngeal Trauma

Airway Obstruction

Agitated
Cyanosis
Noisy breathing
Trachea location

Inadequacy of
Ventilation
Chest movement
Decreased breath
sound
Pulse oximeter

Airway management

Basic Techniques to Open

Airway
1. Head tilt
2. Chin Lift
3. Jaw Thrust

Trias
manouvers

Triple Airway Manuever

Airway devices
1.
2.
3.
4.
5.
6.

Oropharyngeal Airway (OPA)

Nasopharyngeal Airway (NPA)
Laryngeal Mask Airway (LMA)
Multilumen Esophageal Airway
Laryngeal Tube Airway (LTA)
Gum Elastic Tube / ETTI

Oropharyngeal Airway

Technique
Clear the mouth
and pharynx
Place the airway so
that it is turned
backward as it
enters the mouth
As airway
approaches the
posterior wall of
the pharynx
rotate 180 degrees

Contraindications to Oropharyngeal Airways

Inability to tolerate (gagging,

vomiting)
Airway swelling (burns, toxic gases,
infection)
Bleeding into the upper airway
Absence of pharyngeal or laryngeal
reflexes
Impaired mouth opening (e.g., with
trismus or temporomandibular joint

Nasopharyngeal Airway

Technique
Airway is
lubricated with
anesthetic jelly
Resistance
slight rotation of
the tube

Contraindications to Nasopharyngeal Airways

Narrow nasal airway in young children

Blocked or narrow nasal passages in adults
Airway swelling (burns, toxic gases, infection)
Bleeding into the upper airway
Absence of pharyngeal or laryngeal reflexes
Fractures of the mid-face or base of skull
Clinical scenarios in which nasal hemorrhage
would be disastrous

Laryngeal Mask Airway

(LMA)

Airway adjunct with a cuffed mask-like projection

at the distal end that is introduced to the pharynx

LMA Introduced Through Mouth Into

Pharynx

Tracheal Intubation
Keeps Airway patent
Ensures delivery of high concentration of
oxygen
Ensures delivery of a selected tidal
volume
Isolates and protects the airway from
aspiration of stomach contents
Permits effective suctioning
Provides route for administration of
several medications (Adrenaline, Sulfas
atropine)

Indications
Cardiac arrest with ongoing chest
compressions
Inability of conscious patient in
respiratory compromise to breathe
adequately
Inability of the patient to protect
airway
Inability of the rescuer to ventilate
the unresponsive patient with
conventional methods

 Complications
Traumateeth, lips, tongue,
mucosa,
vocal cords, trachea
Esophageal intubation
Vomiting and aspiration
Hypertension and arrhythmias

Equipment for Intubation

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

Curved vs Straight Blade

Macintosh

Miller

Curved vs Straight Blade

Visualization of Vocal Cords

Tongue
Vallecula
Epiglottis
Glottic
opening

Vocal
cord

Arytenoid
cartilage

Difficult Intubation

L =
E =
M=
O=
N=

Look Externally
Evaluate the 3-3-2 Rule
Mallampati
Obstruction
Neck Mobility

Cricothyrotomy

Tracheostomy
Indications for Tracheostomy
Inability to maintain a patent
airway
Suspected cervical spine
instability (percutaneous
technique only)
Prevention of damage to vocal
cords and (possibly) subglottic
stenosis
Abnormal anatomy
(percutaneous only)
Upper airway obstruction
High inotrope or ventilatory
requirement (relative)
Requirement for
tracheobronchial toilet with
suctioning
Part of larger surgical
procedure (e.g., laryngectomy)

Contraindications to
Tracheostomy
Prolonged orotracheal
or nasotracheal
intubation
Local inflammation
Failure to wean from
ventilation
Bleeding disorder
(relative)
Absence of protective
airway reflexes
Arterial bleeding in
neck/upper thorax

Benefits
Comfort
Reduced need for sedation
Improved weaning from
ventilation
Improved ability to suction
trachea
Prevention of ulceration of
lips and tongue or healing
of such ulcers
Reduced upper airway
injury
Potential for speech and
oral nutrition

Complications
Misplacement of tube
Primary hemorrhage
Pneumothorax or
tension pneumothorax;
hemothorax
Surgical emphysema
Infection
Late hemorrhage
erosion of innominate
(or other) vessels
Tracheoesophageal
fistula

Esophageal-Tracheal
Combitube
E
Distal End
A
C

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

Proximal End

H
D

Esophageal-Tracheal
Combitube

Providing Ventilatory
Support

Mouth to Mouth / Nose

Mouth to Mask
Bag Mask
Independent Lung Ventilation (ILV)
Positive End-Expiratory Pressure
(PEEP)
Continuous Positive Airway Pressure
(CPAP)