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Basic Emergency Airway Management
Basic Emergency Airway Management
Basic Emergency Airway Management
dhs wahyubroto. 1
Objectives
Differentiate the Emergency Airway from elective intubation in the OR Assessment of airway compromise Indications for airway intervention Recognition of the difficult airway Bag-Mask Techniques Laryngoscopy
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Airway Assessment
Assessment for airway compromise or threats and need for interventions Examination for the potentially difficult airway
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Threatened Patency
Inspiratory stridor Snoring ( pharyngeal obstruction ) Gurgling ( blood/ secretions ) Drooling ( epiglottitis ) Hoarseness ( laryngeal edema/ vocal cord paralysis) Paradoxical chest wall movement Tracheal tug Mass - abscess, hematoma, angioedema dhs wahyubroto.
Inadequate Protection
Blood in upper airway Pus in upper airway Persistent vomiting Loss of protective airway reflexes
swallowing reflex is superior to gag reflex
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BVM Ventilation
The most important airway skill Always the first response to inadequate oxygenation and ventilation The first bail-out maneuver to a failed intubation attempt Attenuates the urgency to intubate Do not abandon bagging unless it is impossible with two people and both an OP and NP airway dhs wahyubroto. 15
BVM Ventilation
Requires practice to master One hand to
maintain face seal position head maintain patency
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Technique of Laryngoscopy
Sniffing position to align oralpharyngeal-laryngeal axis Flex neck by placing pillow beneath occiput ( raise 10 cm ) Extend head maximally With laryngoscope
open mouth fully push tongue to left out of view pull upward at 45 degrees
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II - soft palate, uvula visible III - soft palate, base of uvula IV - soft palate not visible
100% grade III or grade IV views
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Dysmobility of joints
( TMJ, alanto-occipital, C-spine)
Disproportion
thyomental, Mallimpadi, etc
Dentition
prominent upper teeth
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Unsuccessful Intubation
Bag the patient Maximize neck flex/ head ex Move tongue out of line of site Maximize mouth opening ID landmarks and adjust blade BURP maneuver Increasing lifting force Consider Miller blade Bag the patient
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