Airway Management

‫بسم اهلل‬
‫الرحمن‬
‫الرحيم‬
Airway Management
By
Assist Prof. Dr. Tarik Sarhan
Airway
Management
and Ventilation
Airway Management
By
Airway Management
By
Airway Management
By
Airway Management
By
‫املصادر الغربية ترد فضل استعمال املنفاخ ‪ -‬وهو الشكل البدائي لجهاز أمبو املستعمل‬
‫‪Assist Prof. Dr. Tarik Sarhan‬‬

‫ً‬
‫حاليا في اإلنعاش التنفس ي ‪ -‬إلى (جمعية انعاش األشخاص الغرقى في أمستردام أوال‬
‫‪Airway Management‬‬
‫ومن ثم استعمل في (الجمعية اإلنسانية امللكية) في إنجلترا عام ‪.1771‬‬
‫الواقعة املختصرة التالية مأخوذة من كتاب (ابن أبي أصيبعة) والنسخة اإلنجليزية منه‬
‫‪By‬‬
‫بعنوان‪Classes of Physicians :‬والعربية (طبقات األطباء)‬
‫كتب في القرن الثالث عشر‬
‫املؤلف عاش بصورة رئيسية في القاهرة ومات عام ‪.1270‬م‪.‬‬

‫يروي ابن أبي أصيبعة‪( :‬جاء في سيرة صالح بن بهلة أن طبيب هارون الرشيد‬
‫والذى كان يعالج ابن عمه إبراهيم‪ ,‬جاءه ليخبره أن به رمق ينقض ي وقت صالة‬
‫العشاء‪.‬‬
‫‪By‬‬
‫وهنا تدخل جعفر بن يحيى وقال‪ :‬يا أمير املؤمنين إن صالح بن بهلة عالم في الطب‬
‫ويحسن إحضاره‬
‫فأمر الرشيد بإحضار صالح وتوجيهه إليه ورده بعد منصرفه من عند ابن عمه‪.‬‬
‫ففعل ذلك جعفر‬
‫وقد التمس صالح بن بهلة أن يقابل الرشيد بالذات ليخبره عن حال ابن عمه إبراهيم‪ .‬فقال‬
‫صالح للرشيد‪ :‬أنا أشهدك يا أمير املؤمنين‪ .‬وأشهد على نفس ي من حضرك أن ابن عمك‬
‫إبراهيم إن توفي في هذه الليلة‪ ,‬فإن كل دابة لي فحبيس في سبيل هللا‪ ,‬وكل مال لي فصدقة على‬
‫‪By‬‬
‫املساكين‪ ,‬ولم أقل ما قلت إال بعلم‪.‬‬
‫وملا كان وقت صالة العشاء ‪ ,‬جاء نعي إبراهيم ابن عم الرشيد‪ ,‬فأخذ يكيل اللوم لصالح بن‬
‫بهلة‪ ,‬فلم يناطقه إلى أن سطعت روائح املجامر‪ ,‬صاح عند ذلك صالح‪ :‬هللا هللا يا أمير املؤمنين‪,‬‬
‫حيا‪ ,‬فوهللا ما مات فأطلق لي الدخول عليه وحدي ثانية‪ ,‬فأذن له بذلك‪.‬‬‫أن تدفن ابن عمك ً‬
‫وأتى صالح بمنفخة‬
‫من الخزانة ونفخ في‬

‫أنف إبراهيم مقدار‬
‫ثلث ساعة‬
‫‪By‬‬
‫وعاش إبراهيم بعد‬
‫ذلك ً‬
‫دهرا‪ ,‬ثم تزوج‬ ‫اضطرب بعدها‬
‫العباسة بنت‬ ‫بدنه وجلس أمام‬
‫املهدي وو لي مصر‬ ‫الرشيد‪.‬‬
‫وفلسطين‪.‬‬
Facts
IS AIRWAY MANAGEMENT IS IMPORTANT?
Airway Management
By
CPR Facts
About 75 percent to 80

percent of all out‐of
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hospital cardiac arrests
happen at home
By
So being trained to
perform (CPR) can
mean the difference
between life and death
for a loved one.”
AHA Guidelines
Airway Management
By
Airway Management
By
Airway Management
By
Introduction
 Establishing and maintaining a patent

airway and ensuring effective oxygenation
Airway Management
and ventilation are vital to patient care.
 The human body needs a constant supply of
oxygen to carry out the physiologic
By
processes necessary to sustain life; the
airway is where it all begins.
 To preserve life, the airway must remain
patent at all times—regardless of the
situation.
Introduction

Airway Management
By
Brings in oxygen
Respiratory system Eliminates carbon dioxide
Vital organs will not function properly if process is interrupted.

Introduction

Airway Management
 Failure to manage the airway is a major cause of
preventable death in the prehospital setting.
By
 Understand the importance of:
 Early detection of airway problems
 Rapid and effective intervention
 Continual reassessment
 The airway management techniques are
among the most crucial skills for you as a

paramedic.
Airway Management
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Introduction

Airway Management
 Appropriate airway management
 Open, maintain patent airway
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 Recognize, treat obstructions
 Assess ventilation, oxygenation status
 Administer oxygen.
 Provide ventilatory assistance.
Anatomy

Airway Management
Ventilatory Oxygenation
support and ventilation
By
Oxygen Assessment
therapy &Obstruction
Airway
management
Airway Management
 To effectively manage a patient’s
airway, you must identify key
anatomic structures and
Anatomy
By
understand how those structures
may need to be manipulated
when inserting various airway
devices.
all structures above the glottic opening
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
(glottis), or the space between the
Anatomy of vocal cords.
the Upper
 When you perform skills such as
By
endotracheal (ET) intubation, you must
identify the upper airway anatomy
Airway  Larynx
 Divides upper and lower airways
Airway Management
Anatomy of  the tongue is the first—and largest—
anatomic structure that must be
the Upper
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manipulated when managing a
patient’s airway
Airway
The Tongue is the
most common
cause of Airway
Obstruction
Airway Management
Anatomy of
the Upper
By
 At the base of the tongue, the uvula
extends from the soft palate in the
Airway posterior oral cavity; manipulation of the
uvula is usually unnecessary, although the
uvula is an important anatomic landmark
to identify as you proceed to the posterior
pharynx.
The pharynx is a muscular
tube that extends from
the nose and mouth to it is composed of the
the level of the
esophagus and trachea;

Airway Management
Anatomy of nasopharynx,
the Upper
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Airway oropharynx,
and
the
laryngopharynx
(hypopharynx).
Anatomy
of the
Upper
Airway
Anatomy
Anatomy of the
Lower Airway

Airway Management
from the glottis to the
pulmonary capillary
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membrane.
Exchanges oxygen and

carbon dioxide
Larynx

Airway Management
The thyroid cartilage is a shield-
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Marks where the upper airway
shaped structure palpable on
ends and lower airway begins
the anterior neck.
The Adam’s apple is more

The laryngeal prominence, prominent in men than in
known as the Adam’s apple, is women, and it can also be
immediately inferior to the difficult to palpate in patients
thyroid notch. with obesity or patients with
short necks.
Larynx

Airway Management
Cricoid cartilage (cricoid ring)
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• lies inferior to the thyroid cartilage;
• it forms the lowest portion of the larynx
• the only circumferential ring of the trachea(the
other tracheal rings are semicircular).
• The cricoid ring is more prominent in females
than it is in males.
Larynx

Airway Management
Cricothyroid membrane: ligament between the
thyroid and cricoid cartilage
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• Site for emergency surgical and nonsurgical
access to the airway (cricothyrotomy)
• it is bordered laterally and inferiorly by the highly
vascular thyroid gland, you must locate the
anatomic landmarks carefully when accessing
the airway via the cricothyroid membrane.
CORDS
Glottis
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SPACE BETWEEN THE VOCAL
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The epiglottis

Airway Management
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(a leaf-shaped
When you perform ET
cartilaginous structure that
intubation, you must
closes over the trachea
visualize the epiglottis,
during swallowing) is
glottis, and vocal cords
located at the superior
before inserting the ET tube
border of the glottis.
Vallecula

Airway Management
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Pocket
Important
between base
landmark for ET
of tongue and
intubation
epiglottis
Trachea

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Conduit for air entry into Esophagus lies posterior
the lungs to the trachea
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•Begins below the
cricoid cartilage
•Descends down the
midline of the neck and
chest to the fifth or sixth
thoracic vertebra
Structures of the
Lower Airway

Medical Emergeny
 Tracheobronchial tree
…..Trachea—trunk of tree
Carries air to the lungs
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
 Extends from the larynx to the

mainstem bronchi
 The point at which the tracheal
cartilage bifurcates is called the
carina.
 The carina is at roughly the level
of the fifth intercostal space.
Structures of the
Lower Airway

Medical Emergeny
 In adults, the right mainstem bronchus
typically branches at a less acute angle than
the left. This explains why an endotracheal
By
(ET) tube that is advanced too far almost
always goes into the right mainstem bronchus
in an adult.
 Similarly, aspirated foreign bodies often end
up in the right mainstem bronchus.
Structures of
 Tracheobronchial tree (cont’d)

 Mainstem bronchi branch into:
Medical Emergeny
the Lower 

Lobar bronchi
Segmental bronchi
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 Subsegmental bronchi
 Bronchioles
Structures of the Lower Airway
 Bronchi and bronchioles are lined with cilia.

Medical Emergeny
Inset photo: © Dr. Kessel &
Dr. Kardon/Tissue &
Organs/Visuals Unlimited.
© Dr. Kessel & Dr.
Kardon/Tissue &
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Organs/Visuals Unlimited
Inset photo: © Dr. Kessel &
Dr. Kardon/Tissue &
Organs/Visuals Unlimited.
Structures of the
Lower Airway

Medical Emergeny
 Bronchioles
 Significant amount of gas
exchange
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 The terminal bronchioles are thin
and have little cellular structure
 This anatomic design is helpful for
gas exchange, but it also means
the bronchioles lack cilia, have no
protective blanket of mucus, and
are not shielded by smooth
muscle or more rigid structures.
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Lungs
CONSIST OF SMALLER BRONCHI,
BRONCHIOLES, AND ALVEOLI
Lungs
 Alveoli

 Functional site for the exchange of oxygen
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and carbon dioxide
 Increase surface area of the lungs
Lined with a phospholipid compound
By

(surfactant)
Tarik Saber Sarhan
(tssicu)
www.tssicu.tk

tssicu@gmail.com
Airway Management
tssicu@icloud.com
tssicu@live.com
By
tsarhan@inaya.edu.sa
‫وءاخر دعوانا أن الحمد هلل رب العالمين وصل اللهم على سيدنا محمد وعلى اله وصحبه كلما ذكره الذاكرون‬
‫وغفل عن ذكره الغافلون‬
‫شكرهللا لكم‬
Physiology and
Pathophysiology
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Physiology of Breathing

•Bring
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oxygen
and
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Respiratory and
cardiovascular
systems work nutrients
to cells
together.
•Remove
waste
Ventilation

Airway Management
Process of
moving air into
and out of lungs:
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Two phases
Inhalation Exhalation
(inspiration) (expiration)
Inhalation

 Active, muscular part of
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breathing
 Air enters the mouth and
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nose, moves to the trachea.
 Diaphragm and intercostal
muscles contract.
Inhalation

 Diaphragm
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 Specialized skeletal muscle (voluntary and
involuntary)
Lungs
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
 Have no muscle tissue

 Depend on movement of the chest and
supporting structures
Inhalation

 The thoracic cage expands
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during inhalation and air
pressure within the thorax
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decreases.
 Negative-pressure ventilation
 Inhalation stops when
pressure is equalized.
Inhalation
Thoracic cage:

like a bell jar in
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which balloons
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are suspended
Exhalation

 Passive process and does not normally
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require muscular effort.
 Stretch receptors signal apneustic
center as chest expands
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 Inhibits respiration
 Exhalation occurs
Oxygenation

 Oxygen molecules loaded onto
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hemoglobin molecules in the
bloodstream
 Adequate oxygenation is
By
required for respiration; however,
it does not guarantee that
respiration is taking place.
 Required for ventilation but does
not guarantee it
Oxygenation

 Fraction of inspired oxygen (FIO2)
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 Percentage of oxygen in inhaled air
 Increases with supplemental oxygen
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 Commonly documented as a decimal number
Respiration

Airway Management
 Respiration: process of exchanging oxygen and carbon dioxide
 Involves ventilation, diffusion, and transport of oxygen and carbon
dioxide
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External Respiration
 Exchange of O2 and CO2

between alveoli and blood in
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pulmonary capillaries
 Adequate ventilation is
necessary but does not
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guarantee it.
Internal Respiration

 Exchange of O2 and CO2
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between the systemic
circulation and the cells
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 Kreb cycle and oxidative phosphorylation
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 Energy is produced in the form of ATP.
 Anaerobic metabolism
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 Without adequate oxygen, cells do not
completely convert glucose into energy.
 Cells will eventually die.

 When mitochondria use oxygen to convert glucose to energy,
Airway Management
carbon dioxide accumulates in the cell.
 Without oxygen, anaerobic metabolism leads to cell death.
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Airway Management
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Pathophysiology of Respiration

 Disruption of pulmonary ventilation, oxygenation, and respiration
Airway Management
causes immediate effects.
 Must recognize and correct immediately
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Pathophysiology of Respiration
 Every
cell needs a

constant supply of
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oxygen to survive.
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Hypoxia
 Tissues and cells do not receive enough oxygen

Varying signs and symptoms, including:
Airway Management

 Early signs: restlessness, irritability, tachycardia, and anxiety

 Late signs: dyspnea (may be unable to speak in complete sentences),
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mental status changes, a weak pulse, and cyanosis
Ventilation-Perfusion Ratio and
Mismatch

 Air and blood flow must be directed to the same place at the same
Airway Management
time.
 Ventilation and perfusion must be matched.
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 If not, V/Q mismatch results.
 Blood passes over alveolar membranes without gas exchange.
 Carbon dioxide is recirculated into bloodstream.
Factors Affecting Ventilation

 Patent airway is critical for the provision of oxygen to tissues
Airway Management
 Intrinsic and extrinsic factors can cause an airway obstruction.
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 Intrinsic factors: infection, allergic reactions, unresponsiveness
Airway Management
 The tongue is the most common obstruction in an unresponsive patient.
 Factors may not be directly part of the respiratory system.
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 Extrinsic factors: trauma and foreign body airway obstruction
Airway Management
 Trauma requires immediate intervention.
 Blunt/penetrating trauma and burns can disrupt airflow into the lungs.
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 Trauma to the chest wall can lead to inadequate pulmonary ventilation.

 Hypoventilation
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 Carbon dioxide production exceeds elimination.
 Hyperventilation
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 Carbon dioxide elimination exceeds production.
Circulatory Compromise

 Inadequate perfusion; oxygen demands will not be met.
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 Obstruction of blood flow is typically related to trauma.
 Inhibits gas exchange at the tissue level
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Acid-Base Balance

 Can be disrupted by
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 Hypoventilation
 Hyperventilation
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 Hypoxia
 May rapidly lead to deterioration, death
Acid-Base Balance

 Respiratory and renal systems help maintain homeostasis.
Airway Management
 Tendency toward stability in the body
 Requires balance between acids and bases
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 Acid in the body can be expelled as carbon dioxide from the lungs.
Acid-Base Balance

 Acidosis can develop if respiratory function is inhibited.
Airway Management
 Alkalosis can develop if the respiratory rate is too high.
 Respiratory acidosis/alkalosis
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 Metabolic acidosis/alkalosis
Patient
Assessment:
Airway Evaluation

Airway Management
 Quality of care depends on
assessment
By
Assessing Airway Patency

Airway Management
By
An adult who is responsive, alert,
and able to speak in complete
An unresponsive patient has a
sentences with a normal voice
compromised airway until that is
has no immediate airway
ruled out by a careful
problem. However, because his
assessment.
or her status can rapidly
change, remain watchful.
Signs of airway compromise in an unresponsive
patient

Airway Management
snoring : partial obst.
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vomitus draining from the mouth,
gurgling sound heard during breathing (secretions)>>>

markedly depressed or absent gag reflex >>> significantly
increases the risk of aspiration.
Recognizing adequate Breathing

Airway Management
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Rate 12 - 20 Adequate depth Regular pattern Clear and equal Breathing at rest
breaths/min (tidal volume), breath sounds should appear
bilaterally. effortless,
Normal Respiratory Rate Ranges
Age Range (breaths/min)

 Adults : 12 to 20
Airway Management
 Children (ages 1 to 18 years) : 12 to 37
 Infants (ages 1 month to 1 year) : 30 to 53
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Recognizing Inadequate Breathing

Airway Management
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Breathing rate of less than Shallow breathing Irregular pattern of Adventitious (abnormal)
12 breaths/min or more breathing. breath sounds.
than 20 breaths/min
 Altered mentation
Airway Management
Recognizing 

Cyanosis: indicator of low blood oxygen
Preferential positioning
Inadequate
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 Upright sniffing (tripod) position
Breathing 
 semi-sitting position
Patients experiencing respiratory distress will
avoid a supine position because it will worsen
their breathing difficulties.
Note Position and

Determine Degree of
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Distress
• Prefer sitting positions,
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such as tripod position
• Lying flat may be a sign
of sudden deterioration.
• Ominous sign: head
bobbing
Recognizing Inadequate Breathing
 Airway management  Evaluation includes:
steps:

 Observe
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 Open the airway.  Palpate
 Clear the airway.  Auscultate
By
 Assess breathing.
 Provide appropriate
intervention(s).
Airway Management
By
Inadequate Breathing
 Note the following:

 Position  Use of accessory muscles
Airway Management
 the sternocleidomastoid
 Orthopnea (neck muscles),
 Chest rise/fall  the pectoralis major

muscles,
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 Skin  the abdominal muscles.
 Flared nostrils  Asymmetric chest wall
 Pursed lips movement
 Retractions
 Intercostal?
 suprasternal notch?
 supraclavicular fossa?
 Subcostal?
 Signs:

 Fewer than 12, more  Reduced flow
Airway Management
than 20 breaths/min  Unequal chest
plus dyspnea expansion
 Irregular rhythm  Increased effort
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 Diminished, absent, or  Shallow breathing
noisy sounds
 Pale, clammy skin
 Abdominal breathing
 Retractions
 Staccato speech

Airway Management
Feel Feel for air movement.
By
Observe Observe chest for symmetry.
Note Note any paradoxical motion.


Airway Management
By
Ask about history of Other symptoms: a Interventions, previous Medications and Risk factors? or
present illness productive cough (if hospitalization? overall compliance? “trigger” of the event
yes, then what color is
the sputum?), chest
pain or pressure, or
fever?
Onset, trigger, duration?
Protective
Airway Reflexes

Airway Management
 Evaluate protective reflexes.
 Coughing, sneezing,
gagging
By
 Gag reflex (eyelash reflex)
 Sighing
 Hiccupping
Assessment of
Breath Sounds

Airway Management
 Auscultate breath sounds
with stethoscope.
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 Should be clear and equal
Sounds
of Breath
Assessment
Airway Management
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Assessment
 Duration: length of time for inspiratory and

expiratory phases
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of Breath 

Normal I/E ratio: 1:2
Expiration is prolonged with lower airway
Sounds obstruction.
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 Expiration is short with tachypneic patients.
Assessment
 Pitch: higher or lower than normal (stridor or

wheezing).
Airway Management
of Breath  Intensity of sound depends on:
 Airflow rate
Sounds Constancy of flow throughout inspiration
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
 Patient position
 Site selected for auscultation
Abnormal Breath Sounds
 Wheezing:  Stridor: loud, high-
continuous, high- pitched, heard during

Airway Management
pitched inspiration
 Rhonchi: continuous,  Pleural friction rub:
low-pitched surfaces of visceral
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 Crackles: and parietal pleura
discontinuous rub together
Pulse Oximetry

•simple, rapid,
Airway Management
safe, and
noninvasive
By
•measure the
Pulse percentage of
oximeter hemoglobin with
oxygen attached
•Oxygen
saturation over
95% = normal
Pulse Oximetry

Oxygen saturation should
Airway Management
match patient’s palpated
heart rate.
By
Does not differentiate
between oxygen or carbon
monoxide molecules
Pulse Oximetry
Airway Management
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Pulse Oximetry

 Used for:
Airway Management
 Monitoring oxygenation status during intubation attempt or suctioning
 Identifying deterioration in a patient with trauma or cardiac disease
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 Identifying high-risk patients patients with respiratoryconditions
 Assessing vascular status in orthopaedic trauma
Pulse Oximetry
 Erroneous readings
may result from:

Airway Management
 Bright ambient light  Nail polish
(cover clip)
 Venous pulsations
 Patient motion
By
 Abnormal hemoglobin
 Poor perfusion
End-tidal Carbon Dioxide
Assessment

 Carbon dioxide can be described as the “smoke of metabolism.”
Airway Management
By
Assessment

Airway Management
End-tidal •detect the
carbon presence
By
dioxide of carbon
(etco2) dioxide in
monitors exhaled
or detector air: 3 types
Assessment

Courtesy of Marianne Gausche-Hill, MD, FACEP, FAAP
Airway Management
•indicates whether
carbon dioxide is
present in
reasonable
A amounts
By
•between the ET
colorimetric tube and
carbon ventilation device.
•After 6-8 positive-
dioxide pressure the
detector specially-treated
paper inside the
detector should
turn from purple to
yellow
End-tidal CO2 Assessment

• might give a false- Courtesy of Marianne Gausche-Hill, MD, FACEP, FAAP
Airway Management
positive reading if the
patient has carbon
dioxide trapped in the
Colorimetric stomach
By
• sensitive to extremes of
CO2 temperature and
humidity; it may be less
detector reliable if vomitus or
other secretions get
Limitation inside it;
• the paper inside the
device degrades over
time, resulting in a less
reliable reading.
End-tidal CO2 Assessment

• is a “spot-check”
Courtesy of Marianne Gausche-Hill, MD, FACEP, FAAP
Airway Management
device;you may
use it during initial
Colorimetric confirmation of ET
By
tube placement,
CO2 • but you should
detector replace it as soon
as possible with a
Limitation more accurate
and reliable
quantitative
device.
Assessment

• provides quantitative
Airway Management
information, in real time, by
displaying a numeric
reading of exhaled carbon
dioxide levels.
By
• It uses a special adapter,
which attaches between
Capnometer the advanced airway
device and ventilation
device
• Because it provides
quantitative data, the
capnometer is more
reliable than the
colorimetric co2 detector.
Assessment

Airway Management
• provides a graphic
representation of
exhaled carbon
dioxide levels.
By
Capnogra • It performs the same
function and attaches
pher in the same way as the

capnometer.
• The two types of
capnographers are
waveform and
digital/waveform.
Waveform capnography

 provides quantitative, real-time information
Airway Management
 displays a graphic waveform (Unlike capnometry) .
 has many applications in emergency medicine
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 detection of bronchospasm, hypoventilation, and hyperventilation.
 capnography is the recommended method of monitoring initial and
ongoing placement of an advanced airway device.
 Capnography can also serve as an indicator of the effectiveness of
chest compressions and to detect return of spontaneous circulation
(ROSC).
Airway Management
By
LIFEPAK® defibrillator/monitor. Courtesy of Medtronic.
End-tidal Carbon Dioxide (ETCO2)
Assessment

Phase A–B: initial stage of
Airway Management

exhalation
 Phase B–C: expiratory upslope
By
 Phase C–D: expiratory or
alveolar plateau
 Phase D–E: inspiratory down
stroke
 Phase I (A-B) : the respiratory baseline, the initial stage of exhalation; the
Airway Management
gas sample is dead space gas, free of carbon dioxide.
 Phase II (B-C) : the expiratory upslope.
 At point B, alveolar gas mixes with dead space gas, resulting in an abrupt rise in
carbon dioxide levels.
By
 phase III (C-D): The expiratory or alveolar plateau , the gas sampled is
essentially alveolar.
 Point D is the maximal etco2 level—the best reflection of the alveolar carbon
dioxide level.
 The height of the waveform at point D correlates with the numeric value of
exhaled carbon dioxide that is also displayed on the cardiac
monitor/defibrillator.
 phase IV (D-E) : the inspiratory downstroke, causing the waveform to return
to the baseline level of carbon dioxide— approximately 0 mm Hg.
Airway Management
By
Peak Expiratory Flow
 Measured to evaluate
bronchoconstriction

Airway Management
 Increasing: patient is
responding to
treatment
By
 Decreasing: patient’s
condition is
deteriorating
 Perform three times
and take the best
rate.
Arterial Blood Gas Analysis
 Blood is analyzed for pH,
PaO2, HCO3−, base excess,

and SaO2.
Airway Management
 pH, HCO3−: acid-base
status
By
 PaCO2: effectiveness of
ventilation
 PaO2 and SaO2:
oxygenation

Airway Management

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Airway Management

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‫بسم اهلل‬

‫‪Assist Prof. Dr. Tarik Sarhan‬‬

‫كتب في القرن الثالث عشر‬

‫املؤلف عاش بصورة رئيسية في القاهرة ومات عام ‪.1270‬م‪.‬‬

‫‪Assist Prof. Dr. Tarik Sarhan‬‬

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Vital organs will not function properly if process is interrupted.

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Exchanges oxygen and

Assist Prof. Dr. Tarik Sarhan

The Adam’s apple is more

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

 Extends from the larynx to the

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

 Have no muscle tissue

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

 Early signs: restlessness, irritability, tachycardia, and anxiety

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

Assist Prof. Dr. Tarik Sarhan

gurgling sound heard during breathing (secretions)>>>