AIRWAY

MANAGEMENT
DR MALAYANTI SPAN KIC
RS ISLAM JAKARTA CEMPAKA PUTIH

Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

2 RESPIRATORY ANATOMY

• Nose and mouth (warms, moistens, and filters air).
• Pharynx
• Oropharynx
• Nasopharynx

• Epiglottis
• Trachea (windpipe)

Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

3 RESPIRATORY ANATOMY

• Cricoid cartilage
• Larynx (voice box).
• Bronchi
• Lungs
• Visceral pleura (surface of lungs)
• Parietal pleura (internal chest wall)
• Interpleural space (potential space)

Kansas Airway Supplement
Kansas BEMS EMS Educator Task Force

4 RESPIRATORY ANATOMY

• Diaphragm
• Inhalation (active process)
• Diaphragm and intercostal muscles contract, increasing the size of the
thoracic cavity.
• Diaphragm moves slightly downward, ribs move upward and outward.
• The negative pressure in the chest cavity causes air flow into the lungs.

. Kansas Airway Supplement Kansas BEMS EMS Educator Task Force 5 RESPIRATORY ANATOMY • Exhalation (passive process) • Diaphragm and intercostal muscles relax decreasing the size of the thoracic cavity. • Diaphragm moves upward. ribs move downward and inward. • The positive pressure inside the chest cavity causes air flow out of the lungs.

Kansas Airway Supplement Kansas BEMS EMS Educator Task Force 6 ANATOMICAL SOURCES OF VENTILATION PROBLEMS • Upper airway • Lower airway • Head/neck-Brain • Spinal cord • Chest wall .

followed by a decrease • Cyanosis (often a late sign) . Kansas Airway Supplement Kansas BEMS EMS Educator Task Force 7 RESPIRATORY PHYSIOLOGY • Oxygenation .blood and the cells become saturated with oxygen • Hypoxia .P.inadequate oxygen levels in the blood • Signs of Hypoxia • Increased or decreased heart rate • Altered mental status (early sign) • Agitation • Initial elevation of B.

Kansas Airway Supplement Kansas BEMS EMS Educator Task Force 8 ALVEOLAR GAS EXCHANGE • Oxygen-rich air enters the alveoli during each inspiration. • Oxygen enters the blood in the capillaries as carbon dioxide enters the alveoli for exhalation. .

.infant’s and children’s tongues take up proportionally more space in the mouth than adults. • Trachea is softer and more flexible in infants and children. • Pharynx . Kansas Airway Supplement Kansas BEMS EMS Educator Task Force 9 INFANT AND CHILD CONSIDERATIONS • Mouth and nose .generally all structures are smaller and more easily obstructed than in adults.(windpipe) • Infants and children have narrower tracheas that are obstructed more easily by swelling. • Trachea .

. It is the narrowest part of the infant’s or child’s airway. the cricoid cartilage is less developed and less rigid. infants and children tend to depend more heavily on the diaphragm for breathing.like other cartilage in the infant and child. • Diaphragm .chest wall is softer. Kansas Airway Supplement Kansas BEMS EMS Educator Task Force 10 INFANT AND CHILD CONSIDERATIONS • Cricoid cartilage .

Kansas Airway Supplement Kansas BEMS EMS Educator Task Force 11 OPENING THE MOUTH • Crossed-finger technique • Inspect the mouth • Vomit • Blood • Secretions • Foreign bodies • Be extremely cautious • Fingers • Gag or vomit .

. Infants and Children • Jaw thrust maneuver . Kansas Airway Supplement Kansas BEMS EMS Educator Task Force 12 OPENING THE AIRWAY • Head-tilt. chin lift maneuver • Adults vs.

AIRWAY MANAGEMENT ANESTHESIA VIEW .

OVERVIEW • Airway management in the field • Airway management in the hospital • Indications • Priorities • Problems .

OR AIRWAY MANAGEMENT .

FIELD AIRWAY MANAGEMENT .

IN THE OR .

LEARNING GOALS • Identify difficult airway • Proficient bag/mask ventilation • Use of alternative airway techniques • Prepare Intubation • Learn about RSI • Demonstrate Laryngoscopy / Intubation .

THE INTUBATOR .

Ventilate 3. Oxygenate 2. Protect Airway .AIRWAY PRIORITIES 1.

AIRWAY MANAGEMENT • Spontaneous ventilation • Assisted mask/bag ventilation • Controlled mask/bag ventilation • Intubation + controlled ventilation • Surgical airway + controlled ventilation Use the least aggressive means necessary for airway management .

Trauma) .INDICATIONS FOR INTUBATION • Insufficient Oxygenation • Insufficient Ventilation • Loss of airway protection • Impending airway problems (CNS.

PREPARATION • Oxygen • Ambu bag with mask • Suction • Laryngoscope (working) • different size ETT • Suction • Plan B (Adjuncts) .

PREVENTION OF FAILURE • Assess situation • Decision for specific airway management • Communicate • Plan B • Reassess (change plan. if needed) .

FAILURE TO INTUBATE IN THE OR • Use alternative methods • Get help • Wake patient up .

FAILURE TO INTUBATE IN THE FIELD • Use alternative methods • Failure is not an option ! .

AIRWAY ASSESSMENT .

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MALLAMPATI CLASS .

Trauma) .INDICATIONS FOR INTUBATION • Insufficient Ventilation • Insufficient Oxygenation • Loss of airway protection • Impending airway problems (CNS.

TRAINING .

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PREPARATION • Oxygen • Ambu bag with mask • Suction • Laryngoscope (working) • different size ETT • Suction • Plan B .

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LMA ( LARYNGEAL MASK AIRWAY ) .

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RES-Q-SCOPE .

GLIDESCOPE .

SUMBER • CLASSROOM SUPPLEMENT OUTLINE .PPT . • STUDENT MEDIC AIRWAY INTRO 2010 . PPT.