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Anatomy of the Upper Airway

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Anatomy of the Upper Airway

Sinuses

cavities formed bycranial bones

act as tributaries forfluid to & fromeustachian tubes &tear ducts

trap bacteria,commonly infected

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Anatomy of the Upper Airway

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Anatomy of the Upper Airway

From: CPEM, TRIPP, 1998

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Anatomy of the Upper Airway

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Anatomy of the Lower Airway

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Anatomy of the Lower Airway

Occlusion of the bronchiole

Smooth muscle

Foreign body (not shown)

Inflammation

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Lung Volumes & Capacities

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Ventilation

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Ventilation

mixture

Atmospheric

Nitrogen 597.0 torr (78.62%); Oxygen 159.0 torr(20.84%); Carbon Dioxide 0.3 torr (0.04%);Water 3.7 torr (0.5%)

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Anatomy of the Lower Airway

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Alveoli PO2 100 & PCO2 40

PO2 40 & PCO2 46 - Pulmonary circulation - PO2 100 & PCO2 40

Heart

PO2 40 & PCO2 46 - Systemic circulation - PO2 100 & PCO2 40

Tissue cell PO2 46

OxygenatedDeoxygenated

End-Tidal CO2 Monitoring

Laboratory Testing of Blood

Arterial

Venous

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Equipment Review

From AHA PALS

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Airway & Ventilation

Methods: ALS

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Airway & Ventilation

Methods: ALS

Patient Positioning

Goal

Align the 3 planes of

view, so that

The vocal cords aremost visible

T - trachea

P - PharynxO - Oropharynx

From AHA PALS

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Airway & Ventilation

Methods: ALS

Assessing the Possibility of Difficulty in Intubation

Difficulty

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Airway & Ventilation

Methods: ALS

What effect would theangle of the mandiblehave on intubationdifficulty?

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Airway & Ventilation

Methods: ALS

Curved (Macintosh)Blade

Visualize anatomy

Insert from right toleft

Lift upward andaway

Blade in valleculaLift epiglottis

indirectly

From AHA ACLS

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Airway & Ventilation

Methods: ALS

Straight (Miller) Blade

Visualize anatomy

Insert from right to

left moving tongueaway

Lift upward and away

Blade past vallecula

and over epiglottisLift epiglottis directly

From AHA ACLS

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Tube Positioning

From TRIPP, CPEM

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Airway & Ventilation

Methods: ALS

Digital Intubation

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Airway & Ventilation

Methods: ALS

Jet Ventilation

Usually requires high-pressure equipment

Ventilate 1 sec thenallow 3-5 sec pause

Hypercarbia likely

Temporary: 20-30mins

High risk forbarotrauma

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Airway & Ventilation

Methods: BLS & ALS

Pharyngeal Tracheal Lumen Airway

(PTLA)

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Airway & Ventilation

Methods: BLS & ALS

No.1

100ml

No.2

15ml

No.

2

No.

1

No.1

100ml

No.

215ml

No.

2

No.

1

Combitube

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Airway & Ventilation

Methods: BLS & ALS

Laryngeal MaskAirway (LMA)

Use in OR

Gaining use in out-of-hospital

Not useful withhigh airway

pressureNot a replacement

for ETT

Multiple models &

sizes

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LMA

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Airway & Ventilation

Methods: BLS & ALS

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Esophageal Gastric Tube

Airway (EGTA)

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Airway & Ventilation

Methods: BLS & ALS

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Airway & Ventilation

Methods: ALS

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Airway & Ventilation

Methods: ALS

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Airway & Ventilation

Methods: ALS

Examples of

Secondary Tube Placement

Confirmation Devices

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