AIRWAY & BREATHING MANAGEMENT

GELS RS DR SARDJITO

Airway Anatomy
Epiglottis Os. thyroid Os. cricoid Trachea Oesophagus

Pharyngeal wall

BASIS CRANII atap nasopharynx tulang tipis mudah patah

ARAH TUBE

naso-pharyngeal

Plica vocalis

CRICOTHYROIDOTOMY

NORMAL
AIRWAY AND BREATHING *Silent *Rhythm : normal, costocosto-abdominal I:E ratio *Work of breathing: minimal *Cyanotic: none

Airway management
Problem: *Obstruction *Ventilation disturbances *Aspiration Management:

*Keep the airway clear Clear the airway *Insertion of artificial airway *Prevent against aspiration

Cause of Airway Obstruction

Recognition of Airway Obstruction

Airway Management
Without Device With Devices

Emergency Airway Control

Backward tilt of head & chin lift

Suspect neck trauma

CHIN LIFT

HEAD TILT

HEAD TILT never in trauma victims

2. Head tilt & chin lift

X
NECK LIFT

CHIN LIFT

X
HEAD TILT

JAW THRUST

Airway Equipment

Oropharyngeal airway

Nasopharyngeal tube insertion

1.

NasoNaso -pharyngeal tube

Tidak merangsang muntah Hati-hati pada pasien dengan fraktura basis cranii Ukuran u/ dewasa 7 mm atau jari kelingking kanan

2.

Airway Devices OroOro -pharyngeal tube

Jangan dipakai jika reflex muntah masih (+) (Derajat A dan V dari AVPU atau GCS > 10)

Oropharyngeal tube

Oropharyngeal tube insertion

1.

2.

3.

Laringeal Mask Airway

-

LMA classic, unique, proseal, fastrach, cctrach Untuk kasus sulit ventilasi dan intubasi Jenis LMA fastrach dapat dipasang untuk dilanjutkan intubasi ETT (6.0) secara langsung atau dengan bantuan gum elastic bougie ETT dipasang

Laryngeal Mask Airway (LMA)

Use in OR Gaining use in outoutofof -hospital Not useful with high airway pressure Not a replacement for ETT Multiple models & sizes

Laryngeal mask insertion

Trachea Intubation

Orotracheal tube insertion

Nasotracheal tube insertion

Alignment of the 33-Axes - Adnet F.

Normal Extension Sniffing

Adnet F. Anesthesiology 2001; 94, 83 8 healthy conscious volunteers using MRI scanning, it was not possible to align the axes of the mouth, pharynx and trachea in sniffing, extension or neutral positions Alignment of axes requires soft tissue compression and distortion

Anatomic relations for laryngoscopy and endotracheal intubation

Plica Vocalis

No . 2 15 ml

No. 1 100 ml

Combitube

From AMLS, NAEMT

No .2 15 ml
. No 2

N o. 1

No .2

No. 1

No. 1 100 ml

Sellicks Manuever

Used to prevent gastric distention that can accompany intubation and ventilation Technique Apply slight pressure anteriorly over cricoid cartilage Closes off esophagus

OKSIGENASI
Oxygen flow : 3 liter/minute -------ml/seconds ------ml/seconds Tidal volume : -----? -----? Enriched inspiratory oxygen will increased FiO2 20% to FiO2 ---------------? ?

Mask Ventilation

Breathing Support

Back blows

Abdominal thrusts (Heimlich maneuver)

Chest thrusts

Abdominal thrusts (Heimlich maneuver)

Back blows in infant & small children

Needle cricothyroidotomy

Epiglottis

Thyroid cartilage

Cricoid cartilage

Cricothyroid membrane

1.

2.

3.