AIRWAY

MANAGEMENT
DR MALAYANTI SPAN KIC
RS ISLAM JAKARTA CEMPAKA PUTIH
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

2 RESPIRATORY ANATOMY

Nose and mouth (warms, moistens, and filters air).

Pharynx
Oropharynx
Nasopharynx

Epiglottis
Trachea (windpipe)
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

3 RESPIRATORY ANATOMY

Cricoid cartilage
Larynx (voice box).
Bronchi
Lungs
Visceral pleura (surface of lungs)
Parietal pleura (internal chest wall)
Interpleural space (potential space)
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

4 RESPIRATORY ANATOMY

Diaphragm
Inhalation (active process)
Diaphragm and intercostal muscles contract, increasing the size of the
thoracic cavity.
Diaphragm moves slightly downward, ribs move upward and outward.
The negative pressure in the chest cavity causes air flow into the lungs.
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

5 RESPIRATORY ANATOMY

Exhalation (passive process)

Diaphragm and intercostal muscles relax decreasing the size of the
thoracic cavity.
Diaphragm moves upward, ribs move downward and inward.

The positive pressure inside the chest cavity causes air flow out of the
lungs.
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

6 ANATOMICAL SOURCES OF
VENTILATION PROBLEMS
Upper airway
Lower airway
Head/neck-Brain
Spinal cord
Chest wall
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

7 RESPIRATORY PHYSIOLOGY

Oxygenation - blood and the cells

become saturated with oxygen
Hypoxia - inadequate oxygen levels in
the blood
Signs of Hypoxia
Increased or decreased heart rate
Altered mental status (early sign)
Agitation
Initial elevation of B.P. followed by a
decrease
Cyanosis (often a late sign)
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

8 ALVEOLAR GAS EXCHANGE

Oxygen-rich air enters the alveoli during each inspiration.

Oxygen enters the blood in the capillaries as carbon dioxide enters the
alveoli for exhalation.
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

9 INFANT AND CHILD CONSIDERATIONS

Mouth and nose - generally all structures are

smaller and more easily obstructed than in adults.
Pharynx - infants and childrens tongues take up
proportionally more space in the mouth than adults.
Trachea - (windpipe)
Infants and children have narrower tracheas that are
obstructed more easily by swelling.
Trachea is softer and more flexible in infants and children.
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

10 INFANT AND CHILD CONSIDERATIONS

Cricoid cartilage - like other cartilage in the infant and

child, the cricoid cartilage is less developed and less
rigid. It is the narrowest part of the infants or childs
airway.
Diaphragm - chest wall is softer, infants and children
tend to depend more heavily on the diaphragm for
breathing.
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

11 OPENING THE MOUTH

Crossed-finger technique
Inspect the mouth
Vomit
Blood
Secretions
Foreign bodies
Be extremely cautious
Fingers
Gag or vomit
 Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

12 OPENING THE AIRWAY

Head-tilt, chin lift maneuver

Adults vs.. Infants and Children

Jaw thrust maneuver

AIRWAY
MANAGEMENT
ANESTHESIA VIEW
OVERVIEW
Airway management in the field
Airway management in the hospital
Indications
Priorities
Problems
OR AIRWAY MANAGEMENT
FIELD AIRWAY MANAGEMENT
IN THE OR
LEARNING GOALS
Identify difficult airway
Proficient bag/mask ventilation
Use of alternative airway techniques
Prepare Intubation
Learn about RSI
Demonstrate Laryngoscopy / Intubation
THE INTUBATOR
AIRWAY PRIORITIES

1. Oxygenate
2. Ventilate
3. Protect Airway
 AIRWAY MANAGEMENT
Spontaneous ventilation
Assisted mask/bag ventilation
Controlled mask/bag ventilation
Intubation + controlled ventilation
Surgical airway + controlled ventilation

Use the least aggressive means necessary for airway

management
INDICATIONS FOR
INTUBATION
Insufficient Oxygenation
Insufficient Ventilation
Loss of airway protection
Impending airway problems (CNS, Trauma)
PREPARATION
Oxygen
Ambu bag with mask
Suction
Laryngoscope (working)
different size ETT
Suction
Plan B (Adjuncts)
PREVENTION OF FAILURE
Assess situation
Decision for specific airway management
Communicate
Plan B
Reassess (change plan, if needed)
FAILURE TO INTUBATE IN
THE OR
Use alternative methods
Get help
Wake patient up
FAILURE TO INTUBATE IN
THE FIELD
Use alternative methods
Failure is not an option !
AIRWAY ASSESSMENT
MALLAMPATI CLASS
INDICATIONS FOR INTUBATION

Insufficient Ventilation
Insufficient Oxygenation
Loss of airway protection
Impending airway problems (CNS, Trauma)
TRAINING
PREPARATION

Oxygen
Ambu bag with mask
Suction
Laryngoscope (working)
different size ETT
Suction
Plan B
LMA ( LARYNGEAL MASK AIRWAY )
RES-Q-SCOPE
GLIDESCOPE
SUMBER

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