Airways adjuncts

Airways obstruction

1. Neurological

o Decreased level of consciousness

2. Above larynx

o Max-Fax trauma

o Infection - tonsillary hypertrophy

o Foreign bodies

o Neoplasms

3. Larynx

o Laryngeal fracture

o Infection

o Laryngeal oedema: smoke inhalation, radiotherapy

4. Below larynx

o Congenital - subglotting stenosis

o Neck trauma - haemorrhage

o Infection - acute laryngotreachobronchitis

Headlift
Chin lift / Jaw thrust (due to attachment of tongue to mandible via genioglossus muscle)
C-spine immobilisation

Oxygen
Venturi mask
Non-rebreathe mask ~85%
Bag-valve mask

Suction
Yankeur sucker
Can promote vomiting/spasm
Suck only what you can see
Simple Airway

1. Oropharyngeal airway
Sizes 2,3,4
Sized from incisors to angle of mandible
Inserted upside down and rotated

2. Nasopharyngeal airway
Bevelled one end, flanged other end
Insert with safety pin in end to prevent "loss"
Sized according to internal diameter: 6-7mm adults (used to be size of little finger)
Contraindicated in basal skull fracture

3. Laryngeal mask airway

Sizes 3,4,5
Insufflated with (size x 10) - 10mls: ie size 4 gets 30mls air
Tube should lift 1-2cm out of mouth if cuff in correct position
+ insert bite block (ie OPA)
Risk of leakage of air + aspiration

Definitive airway

"Tube in trachea with an inflated cuff"

Prevents aspiration

Indications; relief of obstruction, protects from aspiration, ventilatory requirement, facilitates

suction/toilet

1. Endotracheal tube
Needs: x2 laryngoscopes, stethoscope, magils, bougie, tubes, lube, suction
Detected with CO2 detector or (in arrest) oesophageal suction detector - can detect collapse
Check (1) epigastrium (2) mid axillary line
+ insert bite block (oropharyngeal airway)

Pre-oxygenate
Position head
Thio / Sux / Tube
 2. Cricothyroidotomy
Needle - between cricothyroid membrane, aim 45' down
Surgical - extend head, dissect down

Results in good oxygenation, but poor ventilation - results in hypercarbia (and thus limited to ~45
minutes usage)
Contraindicated in children (under 12) - risk of damage to cricoid cartilage which is the only support for
the paediatric trachea

3. Tracheo stomy

Login or register to post comments