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AIRWAY MANAGEMENT

AIRWAY MANAGEMENT When you can’t breath, nothing else matters Department of Anesthesiology Uniformed Services University of the Health Sciences Establishing A Patent Airway Chin Lift and Jaw Thrust Maneuver Oropharyngeal Airway Nasopharyngeal Airway Laryngeal Mask Airway

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AIRWAY MANAGEMENT

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  1. AIRWAY MANAGEMENT When you can’t breath, nothing else matters Department of Anesthesiology Uniformed Services University of the Health Sciences

  2. Establishing A Patent Airway • Chin Lift and Jaw Thrust Maneuver • Oropharyngeal Airway • Nasopharyngeal Airway • Laryngeal Mask Airway - The above do not protect against aspiration and laryngospasm Department of Anesthesiology Uniformed Services University of the Health Sciences

  3. Mask Ventilation • Can Deliver A High FIO2 • Avoids The Potential Trauma Of Intubation • Does Not Protect Against Aspiration • May Result In Gastric Distension • Laryngospasm Can Occur • Requires Use Of Both Hands Department of Anesthesiology Uniformed Services University of the Health Sciences

  4. Oral/Nasal Intubation • Safe and Common Practice in Patients Undergoing General Anesthesia • Atraumatic Intubation requires Knowledge of Anatomy, Appropriate use of Equipment, and Drugs (Muscle Relaxants) Department of Anesthesiology Uniformed Services University of the Health Sciences

  5. Preoperative Evaluation • Patient History - Prior History of Difficult Intubation - Tumor of Head and Neck - Arthritis - Pregnancy - Trauma - C Spine, Full Stomach Department of Anesthesiology Uniformed Services University of the Health Sciences

  6. Preoperative Evaluation • Physical Examination - Tongue versus Pharyngeal Size - Atlanto - Occipital Joint Extension • Cervical Spine Mobility (normal 35 degrees) - Anterior Mandibular Space • Thyromental distance - normal is 6 cm - Dental Examination (Loose Teeth, Prostheses) Department of Anesthesiology Uniformed Services University of the Health Sciences

  7. Department of Anesthesiology Uniformed Services University of the Health Sciences

  8. Department of Anesthesiology Uniformed Services University of the Health Sciences

  9. Department of Anesthesiology Uniformed Services University of the Health Sciences

  10. Technique For Orotracheal Intubation • Preparation And Equipment (Always Have Suction Available) • Head Position - Alignment Of Oral, Pharyngeal, and Laryngeal Axes • Choice Of Laryngoscope And Endotracheal Tube • Possible Need For Awake Tracheal Intubation - Difficult Airway Algorithm Department of Anesthesiology Uniformed Services University of the Health Sciences

  11. Department of Anesthesiology Uniformed Services University of the Health Sciences

  12. Orotracheal Intubation • Patient’s Head At The Level Of The Xiphoid • Sniffing Position • Laryngoscope In LEFT Hand • Open Mouth • Hold Tracheal Tube In Right Hand Like A Pencil Department of Anesthesiology Uniformed Services University of the Health Sciences

  13. Department of Anesthesiology Uniformed Services University of the Health Sciences

  14. Department of Anesthesiology Uniformed Services University of the Health Sciences

  15. Department of Anesthesiology Uniformed Services University of the Health Sciences

  16. Department of Anesthesiology Uniformed Services University of the Health Sciences

  17. Department of Anesthesiology Uniformed Services University of the Health Sciences

  18. Department of Anesthesiology Uniformed Services University of the Health Sciences

  19. Complications Of Orotracheal Intubation (During) • Dental And Oral Soft tissue Trauma • Hypertension And Tachycardia • Cardiac Dysrhythmias And Myocardial Ischemia • Aspiration • Corneal Damage Department of Anesthesiology Uniformed Services University of the Health Sciences

  20. Complications Of Orotracheal Intubation (Intubated Patient) • Tracheal Tube Obstruction • Endobronchial Intubation • Barotrauma • Accidental Disconnect • Tracheal Mucosa Ischemia • Accidental Extubation Department of Anesthesiology Uniformed Services University of the Health Sciences

  21. Immediate And delayed Complications On Extubation • Laryngospasm • Aspiration • Pharyngitis • Laryngeal Or Subglottic Edema • Vocal Cord Paralysis • Arytenoid Cartilage Dislocation Department of Anesthesiology Uniformed Services University of the Health Sciences

  22. Alternatives To Orotracheal Intubation Under Anesthesia • Awake Orotracheal Intubation • Nasotracheal Intubation - Awake Blind Nasal - Nasotracheal Intubation After Induction • Intubation With Fiberoptic Bronchoscope - Awake versus Under Anesthesia - Orotracheal versus Nasotracheal • Retrograde Intubation Department of Anesthesiology Uniformed Services University of the Health Sciences

  23. Verification Of Correct Tube Placement • Symmetric Chest Movement • Symmetric Breath Sounds • End tidal Carbon Dioxide - Greater Than 30 For 3-5 Breaths • Condensation Of Water In The tube • Palpation Of Cuff In Suprasternal Notch • Fiberoptic Bronchoscopy Department of Anesthesiology Uniformed Services University of the Health Sciences

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