AIRWAY

MANAGEMENT
OT UPDATE TRAINEE
BATCH-XVIII
CH(NC)

CHAIRPERSON- COL S SAWHNEY

 AIRWAY MANAGEMENT

• ANATOMY OF THE AIRWAY – LT COL SAJITHA

• SUPRAGLOTTIC AIRWAY DEVICES – CAPT AKHILA

• INFRAGLOTTIC AIRWAY DEVICES – LT GEETA

• AIRWAY MANEUVERS – LT PREETI

• TECHNIQUE OF LMA INSERTION AND

ENDOTRACHEAL INTUBATION – LT AISHWARIA
ANATOMY OF THE AIRWAY
• Upper Airway • Lower Airway
• Mouth Nose • Trachea
Oropharynx Nasopharynx • Bronchi
• Epiglottis • Alveoli
• Glottis
• Vocal cords
• Larynx
ANATOMY OF THE AIRWAY
 AIRWAY ANATOMY

Vallecula
Epiglottis
True vocaAl cords

False vocal cords

Cuneiform cartilage
(arytenoids)
Pyriform sinus
Corniculate cartilage (arytenoids)
FRONT VIEW OF LARYNX
 AIRWAY ANATOMY

Trachea

Carina

Bronchi
ARTIFICIAL AIRWAY DEVICES
SUPRA GLOTTIC AIRWAYS INFRAGLOTTIC AIRWAY
SUPRAGLOTTIC AIRWAY
DEVICES

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 DEFINITION

• Supraglottic airway devices are devices used for

maintaining a patent airway and help in ventillation
of patient

• Devices are placed above the glottis

• It will not enter the trachea

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 SUPRAGLOTTIC AIRWAY DEVICES
• Oropharyngeal airway

• Nasopharyngeal airway

• Laryngeal mask airways

• I gel
 OROPHARYNGEAL AIRWAY

• Maintain patent airways

• Facilitate delivery of ventilation with a Bag-mask
• used in unconscious patients with no cough or gag reflex
 OROPHARYNGEAL AIRWAY
ADVANTAGES DISADVANTAGES
• Maintain open airway • Due to incorrect size,
• Facilitate suction laryngospasm in awake
patient
• Obtain a better mask fit
• Difficult to use in patient
• Prevent tongue bite with intact gag reflex
• Simple to use
 NASOPHARYNGEAL AIRWAY

• Useful in patients with airway obstruction or the

condition like clenched jaw, preventing placement
of an oral airway
 NASOPHARYNGEAL AIRWAY

ADVANTAGES DISADVANTAGES
• To maintain airway in • Can not be used in
patients with intact gag patients with nasal
reflex deformity
• To apply continuous
positive airway pressure
• Better tolerated than oral
airway
• Can be used when mouth
cannot be opened
LARYNGEAL MASK AIRWAYS

• LMA Classic
• LMA Unique
• LMA Proseal
• LMA Fastrach
• LMA-Ctrach

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 ALL LMA DEVICES HAVE
THREE MAIN COMPONENTS:
• An airway tube with a
standard 15 mm
connector
• A mask that conforms to
the contours of the
hypopharynx with its
lumen facing the glottis
• An inflation cuff channel-
pilot balloon

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LMA SIZES
 LMA CLASSIC

LMA Classic- reusable Silicone

LMA UNIQUE

PVC
Disposible
LMA PRO-SEAL
LMA SUPREME
 INUBAING LMA / LMA
FASTRACH

• Facilitate tracheal intubation with an

endotracheal tube
 I-GEL

• Igel is a second generation supraglottic airway devices with

soft ,gel –like,non inflattable cuff
• It accurately mirror perilaryngeal anatomy
 LARYNGEAL MASK AIRWAY

ADVANTAGES DISADVANTAGES
• Use of minimum technique • It does not prevent
aspiration
• Can be insered without
the use of laryngeoscope • High incidence of
laryngospasm
• Alternative to ETT
• Gastric insufflation
• Can be used for both
spontaneous & controlled
ventilation
INFRAGLOTTIC AIRWAY
DEVICE
 INFRAGLOTTIC AIRWAY
DEVICE
The infraglottic airway device is a device that is inserted
through the glottis into the trachea for maintenance of the
airway & to convey gases to and from the lungs.

- ENDOTRACHEAL TUBE
 PARTS OF ETT

1) The proximal end

2) Patient end
3) Murphys eye
4) Pilot balloon
STANDARD ETT
SPECIAL ETT

DOUBLE LUMEN TUBE

PLAIN UNCUFFED ETT
LASER RESISTANT ETT
 COMPLICATIONS DURING
ENDOTRACHEAL INTUBATION

• TRAUMA • HYPOXEMIA
 Eyes  Failure of oxygen at source
 Upper lip  Improper procedure
 Teeth  Failure of oxygen at delivery site
 Laryngeal injury
 Pharyngeal injury
 COMPLICATIONS AFTER
INTUBATION

• IMMIDIATE • LONG TERM

 Accidental oesophageal  Ulceration of mouth,
intubation pharynx, larynx & trachea
 Rupture of trachea or  Tracheal stenosis
bronchus
 Tension pneumothorax
 HTN, tachycardia
 COMPLICATIONS DURING
EXTUBATION
• Hypoxemia
- laryngospasm
- airway obstruction
• Sore throat
• Vocal cord injury
• Recurrent laryngeal nerve injury
 ENDOTRACHEAL TUBE

ADVANTAGES DISADVANTAGES
• Provides unobstructed • Bronchial spasm
airway • Accidental injury to the
• Once inserted prevents casualty
the casualty from
breathing in secretions
• Makes positive pressure
breathing easier
MANUEVERS FOR OPENING THE AIRWAY

• HEAD TILT/CHIN LIFT

• JAW THRUST
• TRIPLE AIRWAY MANEUVER
• BACK BLOWS
• HEIMLICH MANEUVER
 THE AIRWAY MANEUVER

• A PROCEDURE TO CLEAR AIRWAY

PASSAGE OF PATIENTS WITH UPPER
AIRWAY OBSTRCTION
NEED FOR THE AIRWAY MANEUVER
•TO RELIEVE TONGUE OBSTRUCTION
• TO RELIEVE FOREIGN BODY
OBSTRUCTION
• TO IMPROVE AIRFLOW
 HEAD TILT /CHIN LIFT
• TONGUE - MOST COMMON CAUSE OF
AIRWAY OBSTRUCTION
• EASIER TO PERFORM
• USED IF NO EVIDENCE OF HEAD & NECK
TRAUMA
HEAD TILT/CHIN LIFT
JAW THRUST

GRIPPING ANGLES OF MANDIBLE

TRIPLE AIRWAY MANEUVER

• EXTENSION OF THE HEAD TILT/CHIN LIFT AND JAW

THRUST MANEUVER
MODIFIED JAW THRUST

• IN CERVICAL INJURY
HEIMLICH MANEUVER

 ALSO CALLED ABDOMINAL THRUST

 STANDARD MANEUVER FOR RELIEVING
FOREIGN BODY IN UPPER AIRWAY
 CAN BE PERFORMED IN A CONSCIOUS
OR UNCONSCIOS VICTIM
 EVEN BE SELF ADMINISTERED
HEIMLICH MANEUVER
BACK BLOWS

• RED CROSS RECOMMENDATION

“ 5 TO 5 APPROACH”
• GIVE 5 BACK BLOWS
• 5 ABDOMINAL THRUSTS
• ALTERNATE 5 BLOWS &
• 5 ABDOMINAL THRUST
CLEARING THE AIRWAY
OF
UNCONSCIOUS PATIENT

• LOWER THE PERSON ON HIS/HER BACK

• PUT A FINGER COVERED WITH CLOTH
• SWEEP OUT THE BLOCKAGE
 TONGUE

FOREIGN
BODY
BODY POSITION
• LEFT OR RIGHT LATERAL POSITIONING OF A
PATIENT AIDS AIRWAY MAINTENANCE BY
ALLOWING FLUIDS/VOMITUS TO DRAIN OUT
• ONLY TO BE USED WHEN SPINAL INJURY IS NOT
SUSPECTED
• IF SPINAL INJURY IS SUSPECTED, THE PATIENT
MUST BE SECURED SOLIDLY TO A RIGID BOARD
SO THAT THE BODY CAN BE TURNED TO THE
SIDE AS A TOTAL UNIT.
TECHNIQUES USED IN LMA
AND ENDOTRACHEAL TUBE
INSERTION
• Assess the airway and evaluate the need for
suctioning to remove:
• Foreign bodies
• Liquid
• Blood
• Determine if the patient needs an airway adjunct.
LMA INSERTION
EQUIPMENTS FOR LMA INSERTION
 LMA of appropriate size .
 syringe for cuff inflation
 Water soluble lubricant
 Ventilation equipment (bag
and mask system attached
to oxygen source
 Stethoscope
 Tape or other device(s) for
securing LMA
SLIDE THE MASK INWARD, EXTENDING
THE INDEX FINGER
PRESS THE MASK UP AGAINST THE
HARD PALATE .

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REMOVE THE INDEX FINGER WHILE
HOLDING THE LMA IN PLACE WITH
THE OTHER HAND

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INFLATE THE CUFF

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 REMEMBER WHEN USING LMA

 fully deflate the mask to form flat oval disc.

 Lubricate the posterior cuff surface just before
insertion.
 PROCEDURE OF
ENDOTRACHEAL TUBE
INSERTION
EQUIPMENTS USED IN INTUBATION
 Laryngoscope handle and blade
• Properly sized endotracheal
tube
• Stylet
• Syringe
• Water-soluble lubricant for the
ET tube
• Suction unit with rigid and soft-
tip catheters
• Magill forceps
• Stethoscope
• Commercial securing device
• Secondary confirmation devic e
PROCEDURE:
• Technique: SNIFFING POSITION
 PROCEDURE (CONTD…)
• Open the patient's mouth with the right hand.

• Grasp the laryngoscope in the left hand.

• Spread the patient's lips, and insert the blade

between the teeth, being careful not to break a
tooth.

• Pass the blade to the right of the tongue, and

advance the blade into the hypopharynx, pushing
the tongue to the left.

• Lift the laryngoscope upward and forward,

without changing the angle of the blade, to
expose the vocal cords.
CONTD…
• Then takes the endotracheal
tube, and insert it through
the mouth opening.

• The tube is inserted through

the cords to the point where
the cuff rests just below the
cords

• Finally, the cuff is inflated to

provide a minimal leak when
the bag is squeezed
CONFIRMING ET TUBE PLACEMENT

• Direct visualization of vocal

cords.
• 5 point auscultation:
• Listen over epigastric area
first.
• Then listen upper lobes
and midaxillary regions.
• Watch for chest rise and fall
• capnography
SECURING ENDOTRACHEAL TUBE

• NEVER let go of the tube until secured

Commercial tube holder
Tape
Questions???.....