Principles of Airway

Management

Fauzi Abdillah Susman 1

Basic airway evaluation in all
patients

Dr. Binnions LEMON Law

BONES

The 4 Ds
 Dr. Binnions Lemon Law: An
easy way to remember multiple
tests

L ook externally.
E valuate the 3-3-2 rule.

M allampati.

O bstruction?

N eck mobility.
 L: Look Externally

Obesity
Buck
teeth

Short Recedin
muscular g jaw
neck
Denture
s
L: Look Externally

Macroglossia
Stridor

Facial
trauma
 E:Evaluate the 3-3-2
rule
3 fingers fit in mouth- Inter incisor
distance
3 fingers fit from mentum
to hyoid cartilage
2 fingers fit from the floor
of the mouth to the top of
the thyroid cartilage

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 M: Mallampati
classification

soft palate, fauces;

Class-I the soft palate, fauces
uvula, anterior and Class-II
and uvula
the posterior
pillars.

Class-III soft palate and base of uvula Only hard palateClass-IV

O:
Obstruction?
Blood
Vomitus
Teeth
Epiglottis
Dentures
Tumors
 N:Neck mobility
-Measurement of
Atlanto-Occipital Angle
 Thyro- Mental Distance

Measure from upper edge of thyroid cartilage to chin with

the head fully extended.
A short thyromental distance = an anterior
larynx .
> 7 cm is usually = easy intubation
< 6 cm = difficult airway

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 Indications for airway
protection
Decreased level of consciousness
GCS <9
Cerebral injury
Surgery
Medical problems

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 Potential causes of airway
obstruction
Tongue
Dentures
Food stuffs
Vomit
Blood
Secretions

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 Techniques to clear material
from airway
Suction
Postural airway manoeuvres
Basic life support chocking protocol
Up to 5 back slaps
Up to 5 abdominal thrusts
Only if unconscious up to 5 chest thrusts
If unsuccessful to clear airway then
Basic Life Support

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 Opening the Airway
Check the airway
Open the airway, place one hand on the
victims forehead and gently tilt head
back
Remove any visible obstruction from the
victims mouth, including dislodged
dentures. Leave well fitting dentures in
place
DO NOT ATTEMPT ANY FINGER SWEEPS
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Opening the airway

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Jaw thrust technique may be
needed if C-spine injury

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Simple airway adjuncts

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Nasopharyngeal airway
insertion

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Oropharyngeal airway
insertion

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 Laryngeal Mask Airways

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 The Laryngeal Mask Airway
Latex-free, silicone
rubber tube connected
to an elliptical mask with
an inflatable outer rim
Standard 15 mm male
adaptor
Pilot tube and balloon
attached to the inflatable
outer rim
Bars cover the connection
between the tube and the
mask
Re-useable up to 40 times
(Autoclave)

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 Insertion Technique
Open the mouth and
press the tip of the cuff
upward against the palate
and flatten the cuff
against it
Use index finger to guide
LMA, pressing backwards
along the palate towards
ears until resistance is
felt
The tip now rests in the
hypopharynx

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 Insertion Technique
Use other hand to press
down on LMA tube while
removing index finger
Inflate with 2-4 ml air to
seal (60 cm H20
maximum)
Dont hold the tube
while inflating the
balloon, it moves
outward a little as it
seats properly

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 LMA in Place

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 Intubation

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 Nasotracheal intubation

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 Questions

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