Emergency Airway

Management
Basic Airway Management

 Airway assessment

 Airway maintenance

 Ventilation assessment

 Ventilation management

 Reassessment
 Airway Assessment

 Look
Agitated, obtunded, cyanosed
Accessory muscle use
Deformity from airway trauma
Airway debris (blood, vomitus, secretions,
food, teeth

 Listen
Abnormal breathing sounds
Gurgling, stridor, hoarseness, snoring
 Airway Assessment

 Palpate
Trachea deviation

 Consider difficult airway

Small chin, protruding dentition, obese, facial
hair
 Tests for airway assessment

 Generally applied for non-emergency airway

assessment

 Interincisor gap:
 The distance between incisors with the mouth open
maximally

 Mallampati test:
 Examine the oropharynx with patient’s mouth open
maximally and tongue protruding without phonating

 Extension of upper cervical spine

 Tests for airway assessment

 Thyromental distance (Patil test)

 Sternomental distance (Savva test)

 Wilson’s score:
 5 factors (cumulative score)
 Weight
 Upper cervical spine mobility
 Jaw movement
 Receding mandible
 Buck teeth
 Airway Maintenance

 Basic airway maintenance

Head tilt, chin lift
Jaw thrust
Suction airway

 Reassess
 Airway Maintenance

 Definitive airway
Cuffed tube secured in the trachea
Orotracheal tube, nasotracheal tube,
cricothyroidotomy

 Required if
Unable to maintain oxygenetaion/ventilation
Apnea
Unable to maintain patent airway with basic
maintenance technique
Risk of aspiration
Head trauma (GCS<8)
 Ventilation Assessment

 Look
Symmetrical chest rise/fall

 Listen
Equal air entry symmetrically
 Ventilation Assessment

 Palpate
Feel for injury
Percuss for haemothorax or pneumothorax

 Adjuncts
Pulse oximetry
Arterial blood gas
CXR
 Ventilation Management

 Supplemental oxygen
Non invasive
Nasal prongs, face mask, bag-valve-mask device
BiPAP,CPAP
Invasive
Endotracheal intubation
Via ventilator

 Life-saving procedure
Needle decompression, chest tube insertion for
pneumothorax or haemothorax
 Emergency airway = Crash airway

 Unconscious

 Maybeassociated with respiratory/cardiac

agony or full arrest

 Immediate
need for supportive airway
management to sustain life
 Cervical spine injury

 Optimal intubation methods

Rapid Sequence Intubation

Tracheal tube introducer recommended

Awake intubation
 Severe head injury

 Optimal intubation methods

Rapid Sequence Intubation

Suxamethonium 1-2mg/kg recommended

Thiopentone 3-5mg/kg if normotensive
 Hypotensive trauma patients

 Optimal intubation methods

Rapid Sequence Intubation

Thiopentone 0.5-1.0mg/kg for hypotensive

Only by trained personnel
Midazolam 0.05-1.0mg/kg for hypotensive
Less haemodynamic disturbance
Mild delay in adequate sedation
Ketamine
Etomidate

Ongoing fluid resuscitation

 Trauma patients with difficult airway

 Optimal intubation methods

Follow recognised protocols

Difficult airway society guidelines

ASA Taskforce
 Emergency airway ≠ Difficult airway

 Clinical situation

Trained
Anaesthesiologist
Emergency physician
ENT surgeon

Difficulty in
Maintaining face mask ventilation
Laryngoscopy
Tracheal intubation
or all the above
 Difficult airway

 Conventionally trained anaesthesiologist

experiences difficulty with facemask
ventilation of the upper airway, difficulty
with tracheal intubation or both

 ASA taskforce 2003

 No standard definition
 Types of difficult airway

 Difficult face mask ventilation

 Difficult laryngoscopy

 Difficult tracheal intubation

 Failed intubation
 Identification of difficult airway

 LEMON© for predicting the difficult

airway

 Look externally
 Evaluate 3-3-2 (size of the mandible,
hyoidmental distance and mouth opening)
 Mallampati
 Obstruction/Obesity
 Neck mobility
 MOANS© for difficult bag mask
ventilation

 Mask seal
 Obesity/Obstruction
 Age (> 55 years)
 No teeth
 Stiff lungs

Technique:
• Head tilt chin lift
• Jaw thrust
 RODS© for difficult supra-glottic
airway placement

 Restricted mouth opening

 Obstruction

 Disrupted or distorted airway

 Stiff lungs or cervical spine

 SMART© for difficult cricothyroidotomy

 Surgery

 Mass

 Access or Anatomy

 Radiation

 Tumor
 The
algorithm
Common airway devices used for
emergency airway

Bag mask
Oropharyngeal valve
airway ventilation

Cuffed and
uncuffed ETT

Nasopharyngeal
airway
COPA LMA Proseal

Pharyngeal- Pharyngeal tube

esophageal tube
THANK YOU