NON-INTUBATION

AIRWAY MANAGEMENT
Benumof & Hagberg, Airway
Management 3rd Ed, 2013
Roberts and Hedges - Clinical Procedure
In Emergency Medicine 5th Ed, 2010
MENTUM-GENOHYOID-
HYOID-THYROID
 SITE OF OBSTRUCTIONS
• Nasal passages
• oropharyngtounge, soft palate lying against
to posterior pharyngeal wallloss of muscle
tone,mass expanding lession,foreign body,OSA
• Hypopharyngepiglottis
• Larynxsecretion and blood-induced
laryngospasm, foreign body, tumour
 SIGN OF OBSTRUCTION
• Additional breath sounds or absence
• No/limited chest expansion
• Increased breathing effort
• Clinical sign symptoms:hypoxemia,
hypercarbia, agitation, obtundation
 BASIC AIRWAY MANAGEMENT
• Simple manuever

• Artificial airway devices

 SIMPLE MANUEVER
• Head-tilt and chin-lift

• Jaw trust

• Triple manuever
HEAD-TILT CHIN-LIFT
JAW THRUST METHOD
 OPA

OVASSAPIAN
 Large anterior flange and
large posterior opening at the
teeth level

GUEDEL
 Fully-closed
SIZE OF OPA
 METHOD OF INSERTION
• Open the mouth widely
• Displace the tounge to upward using tounge
blade
• Place the OPA so it is just off the posterior wall
of the oropharyng, with 1-2 cm protuding
above the incisors
• Perform jaw thrust while the thumbs tap
down the OPA
METHOD OF INSERTION
 MISPLACEMENT AND
COMPLICATION
• If the size is too small  tounge folded and
pushed back
• If the size is too big  the distal-end into
vallecula or pushing the epiglottis to glottis
opening
• Trauma  dental, lip, tounge
• Airway hyperactivity  cough, vomit,
laryngospasm  in lightly-anesthetized or
awake patient
NPA
 INDICATIONS
• Relief upper airway obstruction in
awake,lightly-anesthetized patient
• No adequate relief of OPA placement
• Undergoing dental procedure
• Oropharyngeal trauma
 CONTRAINDICATIONS
• Nasal occlusion
• Nasal fracture
• Marked septal deviation
• Coagulopathy
• Known or suspected of basal skull fracture
• Adenoid hypertrophy
 STEP OF INSERTION
• Inspect the size of nares and its patency
• Use local vasoconstrictor
• Lubricate the tip of the tube
• Gently insert with the concave side parallel to
hard palate until resistance is felt in the
posterior nasopharyng
• Rotate the NPA 90 degress counterclockwise
• Rotate it back to its original orientation
INSERTION OF NPA
 NOT SUCCESSFUL??
•  attempt placement of narrower tube,
redilate the nares, insert into another nares
• Doesn’t pass the oropharyng  withdraw 2
cm and insert suction catheter as a guide
• Cough or react  withdraw 1-2 cm
• Still obstructed after placement  check if
any kinking or obstruction by passing a suction
catheter
 SUCTIONING
• To clear vomit, blood or secretionin airway
• Avoid prolonged suctioning (>15 s) and always
give supplemental O2 before and after
suctioning
• Various suctioning tip:
– Large-bore dental-type
– Yankauer suction  rigid type
– Suction catheter  non-rigid type
TYPE OF SUCTION TIP
 NON-INTUBATION VENTILATION
• Ventilation may be still inadequate despite a
patent airway
• Aid for ventilation,alternative to intubation:
– Mouth-to-mouth/nose
– Mouth-to-face mask
– Bag-valve-mask
– Laryngeal mask airway