Basic Airway Management David G Metro M D

Basic Airway Management David G. Metro, M. D. Associate Professor Department of Anesthesiology www. wiser. pitt. edu

Anesthesiologists are the airway management experts www. wiser. pitt. edu

Lack of an airway usually results in death! Every day, we are responsible for reestablishing an airway that we have taken away www. wiser. pitt. edu

What does airway management mean? • Intubation? • Mask Ventilation? • Other techniques? www. wiser. pitt. edu

The Pharynx http: //www. cortexity. com: 8080/nicksblog/images/pharynx. jpg www. wiser. pitt. edu

The Glottis http: //upload. wikimedia. org/wikipedia/commons/b/bd/Gray 1204. png www. wiser. pitt. edu

Can we predict what an airway will be like? www. wiser. pitt. edu

Mallampati Class • Based on soft tissue (tongue, etc. ) to pharyngeal size • Ask patient to open mouth maximally and protrude tongue as far as possible http: //www. med. univ-rennes 1. fr/resped/s/rea/anes/mallampati. jpg www. wiser. pitt. edu

Mallampati Class http: //www. emsresponder. com/article/photos/1201112829172_46_2. jpg www. wiser. pitt. edu

Atlanto-Occipital Joint Extension • Have patient sit with head facing examiner • The patient then extends the atlantooccipital joint as far as possible • Normal 35 degrees • Greater than 2/3 decrease from 35 degrees is associated with a grade III to IV laryngoscopic view www. wiser. pitt. edu

Thyromental Distance • Have supine patient maximally extend head • Measure from the notch of the thyroid to the tip of the mentum • 6 cm or greater is normal • <6 cm is associated with more difficult intubation www. wiser. pitt. edu

Dental Examination to look for: • Loose teeth • Dental prostheses • Co-existing dental abnormalities www. wiser. pitt. edu

Axes • Aligning the axes gives you the best laryngoscopic view of the glottic opening www. wiser. pitt. edu

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History and the Airway www. wiser. pitt. edu

Physical Exam and the Airway www. wiser. pitt. edu

Ventilation • If you are unable to ventilate someone you have only minutes to do so before permanent damage or death may occur! www. wiser. pitt. edu

Intubation • If you are unable to intubate someone but can ventilate, then you have time to come up with other options! www. wiser. pitt. edu

Indications for endotracheal intubation Provide patent airway Prevent aspiration of gastric contents Need for frequent suctioning Facilitate positive pressure ventilation of lungs Operative position other than supine Operative site near or involving the upper airway • Airway maintenance by mask difficult • Disease involving upper airway • • • www. wiser. pitt. edu

Don’t do something stupid www. wiser. pitt. edu

Complications of tracheal intubation • • • Dental and oral soft tissue trauma Hypertension and tachycardia Cardiac dysrythmias Myocardial ischemia Aspiration of gastric contents www. wiser. pitt. edu

Alternative Airway Techniques • • LMA Intubating LMA Bullard Laryngoscope Gum Bougie Fiberoptic Intubation Combitube Retrograde intubation • • Blind nasal intubation Lighted stylet Digital intubation Jet ventilation Surgical airway COPA Esophageal Obtruator www. wiser. pitt. edu

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www. wiser. pitt. edu

Questions? www. wiser. pitt. edu