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Course Information

• Course Code: ANT210L

• Course Name: Basic Airway Management

• Instructor: Dr. Muhammad K. Muhammad

• Meeting Time: Thursday 2:00 pm to 4:30 pm

Overview

• Objectives of airway management:

  • Review aims of airway management.

  • Overview of airway devices used.

  • Examination of airways.

  • Basic airway maneuvers.

Introduction

• Definition: Non-invasive airway management (NIAM) involves methods to support or maintain airway patency and facilitate adequate ventilation without invasive procedures such as intubation.

Indications for Non-Invasive Airway Management

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• Conditions that warrant NIAM:

  • Respiratory distress from reversible causes which include:

    • Acute exacerbation of COPD.

    • Acute cardiogenic pulmonary edema.

    • Obstructive sleep apnea.

    • Post-operative respiratory support.

    • Hypoxemic respiratory failure.

    • Preventing escalation to invasive ventilation.

Success Criteria for Non-Invasive Ventilation

• Key Indicators of Success:

  • Decrease in dyspnea

  • Increase in alertness

  • Decrease in respiratory rate

  • Improvement in ventilation

  • Increase in pH levels

  • Increase in oxygenation levels

  • Decrease in heart rate

  • Specific values:

    • Decrease in PaCO2

    • Rise of SaO2 to 85% or above

Devices Used in Non-Invasive Airway Management

• Basic Devices:

  • Nasal cannula

  • Oropharyngeal airway (OPA)

  • Nasopharyngeal airway (NPA)

• Advanced Devices:

  • CPAP and BiPAP machines

  • High-Flow Nasal Cannula (HFNC) systems

  • Bag-Valve-Mask (BVM) with reservoir

Nasal Cannula

• Description: Provides supplemental oxygen therapy through two prongs.

• Types:

  • Low flow: Delivers 4-6 liters of oxygen per minute.

  • High flow: Can deliver up to 60 liters of oxygen per minute, often humidified.

Advantages of Nasal Cannula

• Suitable for mild hypoxemia.

• Common in various care settings.

• Allows for eating, drinking, and speaking.

• Simple and cost-effective.

• Comfortable and generally well tolerated.

Disadvantages of Nasal Cannula

• Limited oxygen concentration (FiO2 ~44%).

• Can cause nasal dryness and irritation.

• Ineffective for severe respiratory failure.

Oropharyngeal Airway (OPA)

• Description: A curved plastic tube used to maintain oropharynx patency.

• Size Selection: Based on length from incisors to the angle of the jaw.

  • Sizes commonly used: 2 (small), 3 (medium), 4 (large).

Indications for OPA

• Prevent airway obstruction after anesthesia.

• Maintain patency during difficult mask ventilation.

• Serve as a bite block to protect equipment.

• Aid oropharyngeal suctioning.

Insertion Technique

1. Open the mouth and check for foreign material.

2. Insert the airway upside-down up to the junction of hard and soft palate.

3. Rotate 180° as it moves into the pharynx.

4. Ensure correct placement without causing gag reflex.

Complications of OPA

• Injury to oropharyngeal mucosa.

• Dislodgment of teeth.

• Nausea and gagging.

• Pressure necrosis from prolonged use.

Nasopharyngeal Airway (NPA)

• Description: Hollow tube inserted into the nasal passage.

• Usage: Bypasses mouth or tongue obstructions; preferred in conscious patients.

• Contraindications: Shouldn't be used with suspected skull base fractures.

Insertion Technique

1. Confirm patency of the right nostril.

2. Lubricate the airway.

3. Insert bevel-end first until flange rests at the nose.

4. Check for patency and breathing signs.

Self-Inflating Bag

• Description: Used to ventilate patients; connects to mask or airway device.

• Functionality: Delivers ambient air unless oxygen is attached.

Suction Techniques

• Use a wide-bore rigid sucker for liquid removal.

• Fine-bore catheters may be needed for patients with limited mouth opening.

BiPAP vs. CPAP

• BiPAP: Different pressure levels for inhalation and exhalation.

• CPAP: Constant air pressure during inhalation and exhalation.

Basic Techniques for Opening Airways

• Immediate actions to relieve obstruction:

  • Head Tilt

  • Chin Lift

  • Jaw Thrust

Jaw Thrust Technique

• Identify the mandible angle and apply upward pressure.

• Open the mouth slightly using the thumbs.

Conclusion

• Recognizing airway obstructions and applying the appropriate techniques is critical in emergency airway management.

Questions

• Address inquiries or uncertainties regarding airway management techniques.