The airway

Ed Burdett

23 July 2011
 What is an airway?

A conduit between the lungs and

the outside world
 Airway management:
• Oxygenation

• Ventilation

• Airway protection
 Need for airway
Airway assessment
protection

Airway plan!

My skills and What if it goes

resources wrong?!
 This talk…

• Anatomy
• Assessment
• Managing the airway
• Indications for interventions
• Scenarios
Anatomy
Airway anatomy is important
 Airway assessment
• Look
Pragmatic
• Listen
approach: what
needs to be done to
• Feel the airway?

• (Tests)
Airway
Need for airway
assessment protection

Airway plan!

My skills and What if it goes

resources wrong?!
 Airway assessment - look
• Will a mask create a good seal?

• Appearance/teeth/beard

• Mouth opening - Mallampatti

• Thyromental distance and neck movement

 Look

Mallampatti
 Listen
• Talking

• Breathing
– Stridor - extrathoracic
– Respiratory distress
– Wheeze - intrathoracic
 Feel
• Radiotherapy

• Burns

• Back of neck
Tests
Abnormal anatomy
Abnormal anatomy
 Maintaining the airway

Goal: adequate oxygenation, ventilation, protection

 Need for
Airway assessment airway
protection

Airway plan!

My skills and What if it goes

resources wrong?!
(How) do you need to manage the
airway?
Chin lift, jaw thrust
Airway adjuncts
Measuring

Adult male

Adult female
Other ways to maintain the airway

LMA
• Easy
• Non-traumatic
• Effective

• Stops airway soiling

but not aspiration
Laryngeal mask insertion
The secure airway is a cuffed tube in the
trachea
Direct laryngsocopy
Macintosh >95% success
?
 “Rapid sequence induction”
• Intubation with maximal airway protection
• For those at risk of aspiration
– Full stomach
– Acute abdomen
– Systemically unwell

– Preoxygentation/quick onset drugs/cricoid pressure

 Indications for airway
management
• Oxygenation

• Ventilation

• Airway protection
 Need for airway
Airway assessment
protection

Airway plan!

My skills and What if it goes

resources
wrong?!
 Need for airway
Airway assessment
protection

Airway plan!

My skills and What if it goes

resources
wrong?!
 Making an airway plan
Context
Elective or emergency
Theatre/A&E/ICU
Patient status/surgical plan

Airway assessment
How easy is my plan going to be?

What to do if it goes wrong?

 Example airway plan: elective
hernia repair, healthy 30 yo.
• Plan A – Elective induction, Laryngeal mask

• Plan B – Face mask ventilation +/- Guedel

• Plan C – Call for senior help, wake up

 Case study 1
• You’re asked to assess Mrs Smith for a
laparotomy

• What else do you need to know?

• How do you plan to secure her airway?

• How will you asses her airway?

 Case study 2
• You’re asked to come quickly to A&E because
‘there’s an unwell lady who needs to be
intubated’

• What else do you need to know?

• How do you plan to secure her airway?

• How will you asses the airway?
 Common misunderstandings
“Can we have an anaesthetist to come and intubate
someone in A&E?”

“This kid’s only had sweets…can’t we do his operation

now?”

“This man has stridor and is blue but his sats are 95%
on 15L, so he’s OK, isn’t he?”
In conclusion, plan first so that
performance goes well!

“If you don’t know

where you are going,
any road will get you
there…”
Lewis Carroll