Airway Management

CHAPTER 2Airway Management PRESENTED By INDRIANA1Airway anatomy

Terdiri atas cavitas nasal dan oral.Cavitas nasal terbentuk dari nostril hingga ke nares posteriorNasofaring terbentuk antara akhir cavitas nasal dan palatum moleCavitas oral terdiri dari gigi, palatum mole dan palatum durumOrofaring menghubungkan cavitas ora dan nasofaringOrofaring -> laringofaring

epiglottis yang flexible origate di tulang hyoid dan di dasar lidah. Akan mnutup glottis saat sedang menelan dan melindungi terjadinya aspirasi..

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Saat laringoskopi epiglottis berfungsi sebagai landmark bagi saluran pernapasan3

initial Airway aSSESMENT1. Whether the airway open and protected2. If breathing is present and adequateDilakukan pemeriksaan dengan inspeksi, auskultasi , dan palpasiBenda asing? RR Pergerakan dada suara- stridor: suara pernapasan bernada tinggi -> obstruksi sebagian jalan napas pada level larynx (inspiratory) atau takea (ekpiratory)Snoring obstruksi sebagian di area pharyngealAphonia pada pasien sadar (tanda yng buruk) napas terlalu sulit saat berbicara->respiratory collapse?

5NONinvasive airway managementOpening the airwaySupplemental oxygenVentilation

Ventilation ->6Head Tilt with chin lift

Teknik yang simple namun harus dihindari pada pasien cedera servical7Jaw thrust without head tilt

Oropharyngeal airway

Nasopharyngeal airway

Indications for definitive airway management1. Failure of ventilation or oxygenation2. Inability to maintain or rotect the airway3. Potential for deterioration based on the patients clinical presentation4. Delivery of treatment5. Patient safety and protection

Definitive airway ManagementImmediate crash intubationRapid sequence intubationAwake oral intubationBlind Nasotracheal intubation

Awake oral intubation -> teknik menggunakan liberal topical airway anestesi dan mild IV sedation , digunakan pada pasien disortasi upper airway anatomy.Kerugian: oversedasi, discomfort, stress

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RaPID Sequence INtubation

Possibility of successAnticipating the difficult airway -> LEMONLook externallyEvaluate the 3-3-2 ruleMallampatiObstructionNeck mobility

PreparationThe SOAP MESuctionOxygenAirway EquipmentPharmacyMonitoring Equipment

Pre-oxygenationPemberian 100% O2 pada pasien selam 5 menit -> nitrogen washout 20PREtreatmentLOADLidocaineOpioidAtropineDefasciculation

Paralysis (with induction)

ProtectionCricoid pressure (Sellicks maneuver)

PositioningMemposisikan pasien dalam posisi agar visualisasi glottis terlihat 26

Placement

30PROOF: confirmation of ETT placementClinical assessmentLaryngoscopist observing the ETT pass through the vocal cords during intubationAuscultationAbsence of breath sound in epigastriumObservation of symmetrical chest Observation of condensationPulse oximetriClinical assessmentETCO2 detection and aspiration techniquesCXR

ETT terlalu masuk melebihi karina sehingga ETT ke arah bronkus kanan32Post-Intubation managementFiksasi ETTMonitoring tekanan darah dan tanda-tanda vitalPertimbangan pemberian long term sedation dan NMBATHE DIFFICULT AIRWAY

The Failed AirwayThe cannot intubate, can oxygenateThe cannot intubate cannot oxygenate

36Devices and Techniques for the difficult or failed intubationLighted stulet intubationRetrograde intubationDigital intubationLaryngeal mask airwayCombitubeFiberoptic intubationSurgical Airway managementCricothyrotomyTranstracheal jet ventilation

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Special patientPediatricStatus asthamaticusIncreased intracranial pressureSuspected cervical spine injury

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