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The airway

The airway. Ed Burdett 23 July 2011. What is an airway?. A conduit between the lungs and the outside world. The airway always comes first. A B C D E. Airway management:. Oxygenation Ventilation Airway protection. Need for airway protection. Airway assessment. Airway plan!.

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The airway

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  1. The airway Ed Burdett 23 July 2011

  2. What is an airway? A conduit between the lungs and the outside world

  3. The airway always comes first A B C D E

  4. Airway management: • Oxygenation • Ventilation • Airway protection

  5. Need for airway protection Airway assessment Airway plan! My skills and resources What if it goes wrong?!

  6. This talk… • Anatomy • Assessment • Managing the airway • Indications for interventions • Scenarios

  7. Anatomy

  8. Airway anatomy is important

  9. Airway assessment • Look • Listen • Feel • (Tests) Pragmatic approach: what needs to be done to the airway?

  10. Airway assessment Need for airway protection Airway plan! My skills and resources What if it goes wrong?!

  11. Airway assessment - look • Will a mask create a good seal? • Appearance/teeth/beard • Mouth opening - Mallampatti • Thyromental distance and neck movement

  12. Look Mallampatti

  13. Listen • Talking • Breathing • Stridor - extrathoracic • Respiratory distress • Wheeze - intrathoracic

  14. Feel • Radiotherapy • Burns • Back of neck

  15. Tests

  16. Abnormal anatomy

  17. Abnormal anatomy

  18. Maintaining the airway Goal: adequate oxygenation, ventilation, protection

  19. Need for airway protection Airway assessment Airway plan! My skills and resources What if it goes wrong?!

  20. (How) do you need to manage the airway?

  21. Chin lift, jaw thrust

  22. Airway adjuncts

  23. Measuring Adult male Adult female

  24. Other ways to maintain the airway LMA • Easy • Non-traumatic • Effective • Stops airway soiling but not aspiration

  25. Laryngeal mask insertion

  26. The secure airway is a cuffed tube in the trachea

  27. Direct laryngsocopy

  28. Macintosh >95% success

  29. ?

  30. “Rapid sequence induction” • Intubation with maximal airway protection • For those at risk of aspiration • Full stomach • Acute abdomen • Systemically unwell • Preoxygentation/quick onset drugs/cricoid pressure

  31. Indications for airway management • Oxygenation • Ventilation • Airway protection

  32. Need for airway protection Airway assessment Airway plan! My skills and resources What if it goes wrong?!

  33. Need for airway protection Airway assessment Airway plan! My skills and resources What if it goes wrong?!

  34. Making an airway plan Context Elective or emergency Theatre/A&E/ICU Patient status/surgical plan Airway assessment How easy is my plan going to be? What to do if it goes wrong?

  35. Example airway plan: elective hernia repair, healthy 30 yo. • Plan A – Elective induction, Laryngeal mask • Plan B – Face mask ventilation +/- Guedel • Plan C – Call for senior help, wake up

  36. Case study 1 • You’re asked to assess Mrs Smith for a laparotomy • What else do you need to know? • How do you plan to secure her airway? • How will you asses her airway?

  37. Case study 2 • You’re asked to come quickly to A&E because ‘there’s an unwell lady who needs to be intubated’ • What else do you need to know? • How do you plan to secure her airway? • How will you asses the airway?

  38. Common misunderstandings “Can we have an anaesthetist to come and intubate someone in A&E?” “This kid’s only had sweets…can’t we do his operation now?” “This man has stridor and is blue but his sats are 95% on 15L, so he’s OK, isn’t he?”

  39. In conclusion, plan first so that performance goes well! “If you don’t know where you are going, any road will get you there…” Lewis Carroll

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