Airway Management

L.Dadák, ARK FNUSA

Maintaining airway
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Noninvasive •airway •laryngeal mask •combitube invasive •OTI, NTI •coniotomy •tracheotomy

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vocal cords

First Aid - repetition
• FBAO

First Aid - repetition

Monitoring of breathing
• • • • Auscultation lung + neck SpO2 capnography / capnometry (arterial) blood gasses = Astrup

SpO2 > 90%

CO2

CO2

Kapnograf

Bag Mask ventilation
I: apnea, respiratory failure  positive pressure ventilation Tidal Volume = 6ml/kg = movements of Chest f 10.. 30 /min 21.. 100% O2 1 hand:

4 hands

OroPharyngealAirway
I: unconsciousness + airway obstruction with tongue Correct size OPA: distance angle of mouth --- ear Risk in mild unconsciousness: vomitus + aspiration

LM

LM placed against glottis (radix of tongue, recessus piriformis, esophageal superior sphincter) I: instead face mask, OTI, difficult airway KI:  full stomach  gastro-oesophageal reflux,  high inspiratory pressure  longer operation

Combitube
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emergency situations instead OTI I: difficult airway KI: stenosing process in pharynx / trachea

Tracheal intubation Def: Placing tube to trachea through mouth/nose and larynx. I:  maintain open airway (GCS < 8)  toilet (no cough)  maintain ventilation (shock, hypoventilation) narrowest place in airway – vocal cords – subglotic space (<8let)

OTI, NTI - aids:
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laryngoscope Magill tongs tracheal tubes syringe lead

How to:
• prepare all aids, (ventilate) • position of pat. • LA, GA, coma • direct laryngoscopy • placing tube • inflate cuff • ensure position

Laryngoscope:
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crooked spoon Macintosh straight spoon - Miller

Laryngoscopic view: radix of tongue epiglottis vocal cords trachea

Always easy? (Cormac & Lehane)

Verify placing of the tube
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auscultation End tidal CO2 fibroscopic view

Complications of TI - early:
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trauma of teeth, soft tissue placed to esophagus / endobronchialy aspiration cardiovascular ↑ΒP, ↑f, arrhythmia ↑ ICP laryngospasmus, bronchospasmus

Complication of TI - later:
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damage of vocal cords, trachea sinusitis, otitis, decubitus – lip, nose obturation of tracheal tube by secret, blood

How to do NTI:
1. LA anemisation of nose 2. tube through nose 3. placing tube under visual control CAVE: deviation of septum nasi

Check your neck
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Mallanpati

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3-3-2

Coniotomy
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urgent access to airway lig. cricothyreoideum (lig. conicum)

Coniotomy
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First try to ventilate, OTI find the ligament DO it.

Tracheotomy
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surgical access to trachea punction TS I: maintain AW long time  artificial ventilation  limitation of dead space

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