EMERGENCY AIRWAY

MANAGEMENT

DR.Med.dr. Untung Widodo, SpAn.KIC

Bag. Anestesiologi & Reanimasi
FK UGM, Yogyakarta
2009
 I. Pendahuluan
 Emergency airway management :
= langkah A pada resusitasi
mulai dari menilai jalan nafas s/d
mempertahankan jalan nafas
dalam keadaan baik ( bebas & bersih )

Langkah A dalam keadaan emergensi,

bukan elektif atau terapi definitif suatu
patologi tententu
 Lanjutan Pendahuluan

 THE EMERGENCY PHYSICIAN IS RESPON-

SIBLE FOR AIRWAY MANAGEMENT FOR
PATIENTS IN THE EMERGENCY DEPARTMENT

 TUJUAN AIRWAY MANAGEMENT :

MEMBUAT DAN MENJAMIN JALAN NAFAS
BEBAS UNTUK BERNAFAS (DILEWATI UDARA
INSPIRASI DAN EKSPIRASI DAN MELINDUNGI
/MENCEGAH DARI ASPIRASI
 Lanjutan Pendahuluan . . .

 Manuver / bantuan secukupnya

sampai tercapai tujuan tsb.

 Olehkarena emergency, apa dan

bagaimana melakukan manuver tsb.
tergantung pd SDM dan fasilitas yg
ada pada saat kejadian emergensi.
 Lanjutan Pendahuluan . . .

Intubasi ( Endotrakheal )
Keputusan untuk intubasi berdasar
3 pertimbangan :
- apakah gagal mempertahankan jalan
nafas atau proteksi jalan nafas
- apakah gagal dalam ventilasi atau
oksigenasi
- apakah ada hal klinis yang diantisi-
pasi
 7 langkah Rapid Sequence
Intubation RSI
 Preparation

 Preoxygenation

 Pretreatment

 Paralysis with induction

 Positioning

 Placement with proof

 Postintubation management
 II. Universal Emergency Airway
Algorithm
.
Unconcious, yes fails
Crash airway
Unreactive, algorithm
Near death

no

yes Difficult airway fails Failed airway

Difficult
Algorithm Algorithm
Airway

no

fails
RSI
 III. MAIN EMERGENCY AIRWAY
ALGORITHM
. Need
intubation

yes
Unresponsive, Crash airway
Near death ?

Predict difficult yes

Difficult airway
airway ?

From difficult no
airway

RSI
.
RSI

Attempt
Intubation

yes Post intubation

Successful ? management

no
Failure to yes Failed
Maintain airway
Oxygenation ?
no

≥3 attempts at OT
by experienced
yes
operator ?
 IV. CRASH AIRWAY ALGORITHM
. Crash airway

Maintain
oxygenation

yes
Intubation attemp Post intubation
Successfull ? management

no

yes
Unable to Failed airway
Bag ventilate ?

no

Succinycholine
2 mg/kg iv
. Succynilcholine
2 mg/kg iv.

Attempt
intubation

yes
Post intubation
Successful ?
management

no

yes
Failure to maintain Failed airway
Oxygenation ?

no

≥3 attempts by
experienced operator ?

no
 V. DIFFICULT AIRWAY ALGORITHM

. Difficult Airway
predicted
Call for assistance

Failure to maintain yes Failed

oxygenation ? airway
no

BMV or EGD predicted yes Intubation predicted

to be successful ? to be successful ? RSI

no no

yes Post Intubation

Awake DL, FO, or
management
VL successful ?
or RSI

no

ILMA, FO or VL
Go to main
Cricothyrotomy,
BNTI lighted stylet Algorithm
 VI. FAILED AIRWAY ALGORITHM
. Failed airway Call for assistance

Extraglotic device
May be attempted

Failure to maintain yes

Oxygenation ? Cricothyrotomy

no

Fiberoptic/videolaryngo- If contraindicated
scopy, Extraglotic device,
Lighted stylet,
Cricothyrotomy

yes Post intubation

Cuffed ETT placed ? Management

no

Arrange for definitive

airway management