Control of the Airway

1
Control of the Airway
2
Components of Control of the Airway

• Upper airway maintenance
• Protection of the airway
• Intubation and Ventilation

3
Who Needs Control of the Airway?

• An unconscious patient
• Any patient who cannot maintain adequate air
  exchange
• Cardiac arrest situation
• Respiratory arrest due to drug overdose
• Trauma to the airway

4
Signs of Upper Airway Obstruction in a
Spontaneously Breathing Patient

• Deep snoring
• Use of accessory muscles of respiration
• Retraction of chest wall

5
Confirmation of Obstruction

• Keep hand or face in front of nose and mouth
• Absence of air felt on the hand or face whichever
  applicable
• No movement of bag with respiration if patient
  made to breath via bag and mask

6
Action Required

• Maneuvers to keep airway open
• Head tilt
• Chin lift
• Jaw thrust
• Introduce airway
• Oral
• Nasal
• Endotracheal tube

7
Who Needs Ventilation?

• Patient with no respiratory effort
• With inadequate effort clinical guidelines
• Respiratory rate less than 10 per minute
• Respiratory rate above 40 per minute
• Patient is cyanosed even with O2 supplementation
• Can ascertain only with blood gas analysis

8
Methods of Ventilation

• Bag and mask ventilation
• Intubation and ventilation

9
Benefits of Bag-Mask Ventilation

• Provides immediate ventilation and oxygenation,
  can be instituted immediately, useful for
  neonatal resuscitation
• Possible to have high oxygen concentrations if O2
  reservoir is attached to a self-inflating bag
• Can assist respiration in spontaneously breathing
  patients if respiration is inadequate

10
Problems with Bag-Mask Ventilation

• Tidal volume often inadequate leads to
  hypoventilation
• Without supplemental oxygen can lead to hypoxia
• Can inflate the stomach leads to regurgitation
  of stomach contents, aspiration
• Difficult tasks for each hand one hand holds
  chin lifted and head tilted while achieving
  airtight seal between mask and face
• Other hand required to squeeze out up to 10 mL
  per kilogram from a 1600 mL collapsible,
  self-inflating bag
• Cannot maintain bag and mask ventilation for long
  periods

11
Bag-Mask Ventilation

• Self-inflating bag component parts used for
  maintaining ventilation
• Ambu bag or Oxford inflatable bellows
• Connecting tubes to O2
• Valve (e.g., Ambu E or Rubens valve)
• Close fitting face mask

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Bag-Mask Ventilation (contd)

• Check connection of bag and mask to the valve
• The mask connects to the patient part of the
  valve
• Apply pressure on the bag to make sure that there
  are no leaks and the bag and valve functions
  properly
• Choose the correct size of mask for the patient
• Check the position of the head and neck

13
Keeping Airways Open for Ventilation

• To open the airway
• Extend the head on the neck gently push back
  the forehead so that the head slides back on the
  pillow and the chin is pulled forward and upwards
• Perform the jaw thrust pull the jaw forward
  this pulls the tongue forward away from the back
  of the pharynx
• Maintain forward jaw thrust
• Ventilate with bag and mask

14
Ventilate with Bag and Mask

• Apply face mask to the face use the correct
  size of the mask to fit the face
• Ventilate gently at first
• Maintain ventilation at a rate of 15 to 20
  breaths per minute for adults
• The chest should move up and down with each
  respiration

15
Technique for Holding the Mask Both Hands
16
Technique for Holding the Mask One Hand
17
Adequacy of Ventilation

• Look for the rising and falling of chest
• If not satisfactory then ventilate using other
  adjuvants
• use an oral airway
• nasal airway

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Endotracheal Intubation

• Ideal method of ventilation
• Cuff protects the airway from aspiration

19
Endotracheal Intubation

• Parts
• Tube
• Cuff
• Pilot balloon
• Size 7 for adult female
• Other equipment needed
• Laryngoscope
• Stilette
• Inflating syringe
• Tape

Source Dobson MR. 2000. Anaesthesia at the
District Hospital. WHO.