Airway management I.Basic Airway Management (BAM)

UD FM DAICEnglish program practice

2018

Airways

• Anatomy:– Upper airways

Nasal / oral cavity

Pharynx

Larynx

– Lower airwaysTrachea

Bronchi

• Functions:– Conduction – AIR

– Protection – againstaspiration

– (Phonation)2

Signs of compromised airways

• Subjective complaints:– Dyspnea– Choking– Cough– Direct injury (neck / airways)– Sore throat– Hoarseness

• Objective general symptomes(according to hypoxemia):– Skin → cyanosis, paleness– CVS → elevated sypathetic

vegetative tone, arrhytmias– CNS → restlessness, agitation,

delirium, unconsciousness

• Objetive respiratorysymptomes:

– Inspection Respiratory rate (RR) →

tachypnea / bradypnea / apnea Accesory muscles → Increased

work; Paradoxical breathing Inspiration-to-exspiration ratio

(I:E) → prolonged / shortened Posture → orthopnea

– Auscultation Pathological respiratory sounds

→ stridor, wheezing Phonation → dysphonia,

aphonia

3

Airway syndromes

• Upper airway stenosis:

– Inspiratory dyspnea

– RR ↓

– Increased work of inspiratory accesorymuscles

– Paradoxical breathing

– Increased I:E ratio

– Stridor

• Lower airway stenosis:

– Exspiratory dyspnea

– RR ↑

– Increased work of exspiratory accesorymuscles

– Decreased I:E ratio

– Wheezing

4

Main causes of airway obstruction

• Unconsciousness / GCS ≤ 8– Structural or functional damage of CNS– Sedation / anaesthesia

• Foreign body / massive aspiration or bleeding• Trauma

– Mechanic– Burn

• Infections– Epiglottitis– Laryngitis subclottica

• Angioedema (Quincke oedema)• Laryngospasm• Airway tumors• Postoperative complications (e.g. thyroid / carotid surgery)

– bleeding– Laesion of n. laryngeus recurrens

• (Asthma)

5

Pathophysiological processes causedby airway obstruction

• Hypoxemia →

• Dysfunction of high O2-uptake organs (CNS, heart) →

• GCS ↓ (worsens airway obstruction) →

• Dysfunction of brainstem (vital centers) →

• Cardiorespiratory failure →

• Cardiorespiratory arrest6

Management of airway obstruction

• Treatment of the cause• Supportive care:

– MOVE (monitoring, oxygen, venous access, evaluation repeatedly)– Basic Airway Management (BAM)

Manual / BLS Recovery position Reclination („head tilt +chin lift”) Esmarch-Heiberg („jaw thrust”) FBAO protocol

Instrumental / EBLS Naso-, oropharyngeal tubes LMA LT Combitube Airway suctioning

– Advanced Airway Management (AAM) ETI (oro-, nasotracheal) +/- Sellick / BURP Conicotomy / Tracheostomy

7

Recovery position

Head tilt + chin lift / Jaw thrust

FBAO protocol

Finger sweep – NOT ADVISED!

Airway instruments

BAM• Supraglottic airway devices (SAD)

– 1st generation NPT, OPT, COPA, LM (cLMA, fLMA,

iLMA-k: Fastrach, CTrach, Air-Q), LT, CPLA

– 2nd generation PLMA, i-gel, Air-Q Blocker, SLMA,

LTS-II / LTS-D, ETC, GLT, SLIPA, EAD

– 3rd generation Baska mask

AAM• Transglottic devices

– Endotracheal tubes (ETT)– Endobronchial tubes (EBT) /

Blockers

• Infraglottic devices– Conicotomy– Tracheostomy

• Intubation aids– Laryngoscope– Tube guides and introducers– Intubating fiberoscope– Magill forceps

• Tube securing• Airway suctioning

Nasopharyngeal tube (NPT)

• Wendl

• Kotler

• Linder

Oropharyngeal tube (OPT)

• OPT – Mayo-Guedel

• Safar

• Waters

Cuffed Oropharyngeal Airway (COPA)

TULIP airway

Classical Laryngeal Mask Airway(cLMA)

Flexible LMA (fLMA)

LMA Fastrach

LMA CTrach

Cookgas Air-Q Airway

Laryngeal Tube (LT)

Cobra Perilaryngeal Airway (CPLA)

Proseal LMA (PLMA)

i-gel

Air-Q Blocker

Supreme LMA (SLMA)

Sealed LT-k (LTS-II / LTS-D)

Esophago-Tracheal Combitube (ETC)

Gastro-laryngeal tube (GLT)

Streamlined Liner of PharyngealAirway (SLIPA)

Elisha Airway Device (EAD)

Baska mask

Thanks for attention!