AIRWAY+MANAGEMENT++with+narration

Airway Management Overview

  • Focus on techniques and devices to maintain or establish a patient’s airway.

Indications for Artificial Airways

  • Purpose of Artificial Airways:

    • Relieve airway obstruction.

    • Facilitate removal of secretions.

    • Protect the lower airway.

    • Facilitate application of positive pressure ventilation (PPV).

  • Hazards:

    • Hypotension.

    • Vocal cord or laryngeal trauma.

    • Nasal trauma or bleeding.

    • Blockage of the Eustachian tube; possible otitis media.

Airway Protection Mechanisms

  • The body possesses natural mechanisms to protect the airway.

  • Mechanisms can be impaired by brain damage, dysfunction, or drug effects.

Coma and Airway Protection

  • Patients in a coma may retain some airway protective responses, although they are often markedly reduced or absent.

Types of Artificial Airways

Cuffed Endotracheal Tube (ET Tube)

Esophageal Obturator Airway (EOA)

  • EOA Functionality:

    • Inserted into the esophagus with an inflated cuff that seals the esophagus, preventing air from entering.

    • Allows air to pass through pharyngeal holes into the trachea, but does not fully protect airway integrity.

Endotracheal Tube (ET Tube)

  • Purpose: Maintain airway patency, allow ventilation.

  • Placement Points:

    • Oral route for adults: Tube should terminate about 2-6 cm above the carina.

    • Nasal route for adults: Typically placed at 23 cm for females and 25 cm for males.

Oral Airway](a.k.a. Oropharyngeal Airway)

  • Indications:

    • Used for unconscious or unresponsive patients to keep the airway open by displacing the tongue.

  • Disadvantages:

    • Can induce a gag reflex in conscious patients.

  • Sizing Method:

    • Measure from the angle of the jaw to the tip of the chin; patient variations should be acknowledged.

Nasopharyngeal Airways (Nasal Trumpet)

  • Indicated for conscious patients needing frequent suctioning or having difficulty maintaining a patent airway.

  • Placement Guidelines:

    • Adjust position to ensure it slightly projects below and behind the uvula upon insertion.

    • Size the tube smaller than the nasal passage; use lubrication.

Securing and Confirming Placement

  • Adhesive and Tape Usage:

    • Techniques for securing ET tubes include traditional taping and specialized tapes like Hy-Tape for better skin care.

  • Confirmation Methods:

    • Auscultation, chest movement, capnography, fiberoptic laryngoscopy, and chest X-ray remain vital for verifying tube placement.

Troubleshooting Airway Issues

  • Adjust patient positioning, pass a suction catheter, or deflate cuff.

  • If using an inner cannula for tracheostomy, be aware it might need to be removed for certain interventions.

The Laryngeal Mask Airway (LMA)

  • Invented for easier airway management; less invasive than an ET tube but does not prevent aspiration.

  • Useful in anesthesia and emergency situations, especially where intubation is difficult.

The Esophageal Tracheal Combitube

  • Designed as a double lumen tube to function in both the esophagus and the trachea depending on the insertion depth.

  • Aids in quick airway management when traditional intubation isn't possible.

Conclusion

  • Recognizing different airway management devices and techniques is crucial for effective patient care. Ensure regular assessments and adjustments based on individual patient needs.