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Airway and Breathing Management
Aris Sunaryo, dr., SpAn., M.Kes
Department of Anesthesiology & Intensive Therapy
Waled General Hospital
Cirebon
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Awake? /No
Breath ? /No
Airway management
Breath ?/No
Breathing Support 2x
Carotid Pulse /No
Circulation support
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Identify the clinical settingsin which airway compromiseis likely to occur.
Recognize the signs and
symptoms of airwayobstruction.
Describe the techniques toestablish and maintain apatent airway.
Discuss the importance ofadequate oxygenation andventilation in all phases ofairway management.
Objectives
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Airway Assessment
Patient is alert and oriented.
Patient is talking normally.
There is no evidence of injury to
the head or neck.
You have assessed andreassessed for deterioration.
How do I know the airway is adequate?
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Airway Assessment
Signs and symptoms of airway compromise (cont.)
Tachypnea Abnormal breathing pattern
Low oxygen saturation (late sign)
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Anatomi
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Anatomi
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Anatomi
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Airway Assessment
Impending Airway Obstruction
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Recognition of Airway obtruction;
Can not hear and feel of air flow at the mouthand nose for complete airway obstruction
When patients still breathing inspiratory
retraction of intercostal and supraclavicular
Partial airway obstruction : snoring, crowing,
gurgling, wheezing
Hypercarbia : somnolence
Hypoxemia : sympathetic stimulation
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Manual clearing of the airway:The crossed finger maneuver
Finger behind teeth manuever
Tongue jaw lift manuever
Clearing the airway by suction
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Technique for foreign body clearing
If the victim is conscious,
encourage to expel by coughing and spitting it out
Apply abdominal thrust s or back blows
If the victim is unconscious
Apply back blows or abdominal thrust in horizontal
position
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Airway Assessment
When to intervene when the airway is patent
Inability to protect the airway
Impending airway compromise Need for ventilation
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Gambar.Face Mask Dewasa Gambar.Face Mask Anak
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Gambar. cara satu tangan memegang face mask Gambar. jalan nafas yang sulit dapat digunakan
teknik dua tangan
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How do I manage the airway of a traum a patient?
Supplemental oxygen
Basic techniques
Basic adjuncts
Definitive airway
Cuffed tube in the trachea
Difficult airway adjuncts
Unexpected difficult airway
Predicted difficult airway
Airway Management
P i i i h i
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Positioning to open the airway
Head tilt
Neck lift
Chin lift
Jaw thrust
Open the airway using equipment
Oropharyngeal airway
Nasopharyngeal airway
Endotracheal intubation
Cricothyroidotomy and Tracheostomy
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Protect the cervical spine during airwaymanagement!
Airway Management
Caution
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Airway Management
Chin-li f t Maneuver
Basic Techniques
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H
Chin Lift Neck Lift
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Airway Management
Jaw-thrust Maneuver
Basic Techniques
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Airway Management
Oropharyngeal airway
Basic Adjuncts
Patients who can tolerate an oral airway will
usually need intubation.
Nasopharyngeal airway
Often well tolerated
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GambarA : Penempatan Oropharingeal Airway, B : Penempatan Nasopharingeal Airway
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Airway Management
I s this a diff icul t airway?
How would you manage this
patient?
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Airway Management
Preoxygenate Cricoid pressure
Sedate (midazolam) Paralytic (succinylcholine) Intubate Confirm (Auscultate, CO2) Release cricoid pressure and ventilate
Definitive Airway Easy
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Tabel.Variasi LMA dengan Perbedaan Volume Cuff yang Disediakan untuk Pasien yang
Berbeda Ukuran
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Tabel.Keuntungan Dan Kerugian Dari LMA Dibandingkan Dengan Face Mask Dan ETT
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usia Diameter internal (mm) Panjang (cm)
Bayi cukup bulan 3,5 12
Anak anak 4 + usia/4 14 + usia/2
Dewasa
Wanita 7.0-7,5 24
Laki-laki 7,5-9,0 24
Tabel.patokan ukuran ETT.
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Gambar. posisi aman dan intubasi dengan blade macinthos
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Gambar.sisi yang diauskultasi untuk suara nafas pada dada dan lambung.
Selama laringoskopi dan intubasiMalposisi
I t b i h
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Intubasi esophagus
Intubasi bronchial
Posisi cuff laryng
Trauma jalan nafas
Gigi rusak
Lacerelasi lidah, bibir dan mucosa
Dislokasi mandibula
Retropharingeal diseksiReflek fisoilogi
Hipoksia, hiperkarbi
Hipertensi, takikardi
Hipertensi intracranial
Hipertensi intraokuler
Laringospasme
Malfingsi pipa
Perporasi cuff
Bergesernya pipa
Malposisi
Unitentional ekstubasion
Intubasi bronkhial
Posisi cuff laringeal
Trauma jalan nafas
Inflamasi mucosa dan ulcerasi
Exkoreasi di hidung
Malfungsi pipaTerbakar
Obstruksi
Menyertai ekstubasi
Trauma jalan nafas
Edema dan stenosis
Serak
Malfungsi laring dan aspirasi
Laringospasme
Tekanan negatif edema paru
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Tumor
Higroma kistik
Hemangioma
HematomaInfeksi
Abses mandibula
Abses peritonsiler
Epiglotitis
Kelainan kongenital
Sindroma pierre robin
Sindroma treacher collin
Atresia laring
Sindrom goldenharDistosia craniofacial
Benda asing
Trauma
Fraktur laring
Fraktur mandibula atau maxilla
Inhalasi burn
Cedera servikal
Gemuk
Extensi leher yang tidak adekuatRhematoid artritis
Spondilitis
Halo traksi
Variasi anatomi
Mikrognathia
Prognathia
Lidah yang besar
Celah palatum
Leher pendek
Tabel. Kondisi yang Dihubungkan dengan Kesulitan Intubasi.
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Gambar. klaifikasi mallampati.
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Airway Management
I s this a diff icul t airway?
How would you manage this
patient?
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Airway Management
Get help
Be prepared
Consider rapid sequence intubation vs. awakeintubation
Maintain c-spine immobilization
Consider use of: Gum elastic bougie
LMA / LTA
Surgical airway
Other advanced airway techniques, eg, fiberopticintubation
Definitive Airway Difficult
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Airway Management
Surgical airway
Cricothyroidotomy
Needle
Definitive Airway
Surgical
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Airway Decision Scheme
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How do I know the tube is in the r ight place?
Visualize it going through
the cords Watch the chest
Auscultation
Pulse oximeter CO2 detector
Radiology
Airway Confirmation
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Summary
Suspect airway compromise in all injured patients.
Adjuncts for establishing a patent airway include:
Chin-lift and jaw-thrust maneuvers
Oropharyngeal and nasopharyngeal airways
Laryngeal mask airway
Multilumen esophageal airway
Gum elastic bougie device
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Summary
A definitive airway requires a tube placed in the
trachea (inflated cuff, oxygen, assisted ventilation,
airway secure).
Oxygenated inspired air is best provided via a tight-
fitting oxygen reservoir face mask with a flow rate of
greater than 11 L/min.
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Thank you