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Pra Bedah 2013

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Thyroid Cartilage Cricothryoid Space Cricoid Cartilage Trachea


Cricothyroid Membrane Tracheal Ring

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Obstruction of the portion of the airways located above the thoracic inlet Nose Nasopharynx Oropharynx Larynx (supraglottis, subglottis) Trachea (extrathoracic)

Mc Pherson K et al. Managing Airway Obstruction. British Journal of Hospital Medicine, October 2012, Vol 73, No 10

Stridor (Inspiratoar) Hoarseness (involvement of vocal cords) Respiratory distress (suprasternal retraction) Cough Signs of hypoxemia Anxiety Restlessness Tachycardia Pallor Cyanosis: late sign

Recession (sternal, lower costal margin) Tachypnoea Tachycardia Expiratory difficulty (abdominal muscles contract) Depressed consciousness Cyanosis Noise soft/absent

Snoring Retraction of the sternum Rocking motion of the chest not in sync with respiratory effort Harsh, high-pitched sound upon inspiration (stridor) Hypoxemia Hypercarbia

Lack of any air movement Lack of breath sounds Retraction of the sternum & rib cage Rocking motion of the chest not in sync with respiratory effort Hypoxemia Hypercarbia

Lower Airway Obstruction: Air trapping (percussion), Upper border of liver displaced downwards, Cardiac dullness not detected

Anamnesis: usia, riwayat penyakit sebelumnya Pemeriksaan fisik Pemeriksaan penunjang: simultan

Tracheal deviation Extrinsic compression Radiopaque foreign bodies Lateral insensitive & delay in securing the airway

Hammer J. Aqcuired Upper Airway Obstruction. PAEDIATRIC RESPIRATORY REVIEWS (2004) 5, 2533

Hammer J. Aqcuired Upper Airway Obstruction. PAEDIATRIC RESPIRATORY REVIEWS (2004) 5, 2533

Stable patient or in the unstable patient with an already secured airway. High-resolution CT: intrinsic and extrinsic tumors, vascular structures, and foreign bodies. Degree and extension of airway compromise

Gradual and mild symptoms of UAO. Relatively insensitive & has no role in acute respiratory distress Analysis of the flow-volume loops may be helpful suggesting the location and functional severity of the obstruction

Most effective tool (diagnosis & tx). Rigid bronchoscope (emergency setting) Flexible bronchoscopy (establish the diagnosis, deliver treatment: laser therapy, photoresection, electrocautery, electrosurgery, balloon bronchoplasty, and tracheal stenting)

Traumatic causes : Laryngeal stenosis, Airway burn, Acute laryngeal injury, Facial trauma (mandibular or maxillary fractures), Hemorrhage Infections: Suppurative parotitis, Retropharyngeal abscess, Tonsillar hypertrophy, Ludwigs angina, Epiglottitis, Laryngitis, Laryngotracheobronchitis (croup), Diphtheria Iatrogenic causes: Tracheal stenosis post-tracheostomy, Tracheal stenosis post-intubation, Mucous ball from transtracheal catheter

Foreign bodies Vocal cord paralysis Tumors: Laryngeal tumors (benign or malignant), Laryngeal papillomatosis, Tracheal stenosis (caused by intrinsic or extrinsic tumors) Angioedema: Anaphylactic reactions, C1 inhibitor deficiency, Angiotensin-converting enzyme inhibitors

Establishing a secure and patent airway Medical Interventions: Heimlich maneuver, Oropharyngeal airways, Endotracheal intubation (transnasally or orally), Racemic epinephrine, Corticosteroids, Heliumoxygen mixture Surgical or Bronchoscopic Interventions Fiberoptic intubation Cricothyroidotomy Tracheostomy Laser/electrocautery/balloon dilation Airway stenting

Using a 12 or 14-gauge cannula: extreme emergency, unable to do an open cricothyroidotomy, and in children. Effective ventilation: cannula attached to high pressure jet ventilation.

Indikasi: Airway obstruction proximal to the subglottis Respiratory failure Pulmonary toilette Bronchosopy

Mc Pherson K et al. Managing Airway Obstruction. British Journal of Hospital Medicine, October 2012, Vol 73, No 10

Tindakan operatif membuka trakea, yang bisa merupakan tindakan sementara atau terkadang merupakan tindakan permanen membuat stoma pada trachea. INDIKASI : Obstruksi mekanik saluran nafas atas (kongenital, infeksi, keganasan, trauma, paralisis pita suara, dan benda asing) Melindungi saluran nafas bawah dari resiko aspirasi (GBS, MS, Miastenia Gravis, Tetanus, koma, Trauma yang menyebabkan banyak perdarahan di saluran nafas atas).
Update of Surgical Airway Management. Simposium, workshop, and hands on experiences XX. Surabaya, 9-10 September 2012. Hai AA and Ahmed SW. Islamic Legacy of Modern Surgery. IOS Minaret 2010;Vol. 5 Issue 8 01 - 15 September

Kondisi Gagal Nafas (PenyakitParu: Bronkitis kronis, emfisema paru, asma berat, pneumonia; Penyakit saraf: MS, motor neuron disease; Trauma berat pada dada: flail chest, multiple Fraktur kostae) Retensi Sputum Trakeostomi Elektif, mengiringi tindakan operatif daerah kepalaleher

Zollinger RM, Ellison EC. 2011. Zollinger's Atlas of Surgical Operations. 9th edition. New York. McGraw Hill.

Zollinger RM, Ellison EC. 2011. Zollinger's Atlas of Surgical Operations. 9th edition. New York. McGraw Hill.

Zollinger RM, Ellison EC. 2011. Zollinger's Atlas of Surgical Operations. 9th edition. New York. McGraw Hill.

Early complications Pneumothorax, bleeding, decannulation, obstruction, infections Late complications Granuloma, decannulation, tracheocutaneous fistula

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Mc Pherson K et al. Managing Airway Obstruction. British Journal of Hospital Medicine, October 2012, Vol 73, No 10 Hammer J. Aqcuired Upper Airway Obstruction. PAEDIATRIC RESPIRATORY REVIEWS (2004) 5, 2533 Update of Surgical Airway Management. Simposium, workshop, and hands on experiences XX. Surabaya, 9-10 September 2012. Zollinger RM, Ellison EC. 2011. Zollinger's Atlas of Surgical Operations. 9th edition. New York. McGraw Hill.