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Flashcards in Airway Equipment and Management Deck (16)
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1

Types of Airway Support

A) Spontaneous Ventilation
B) Mask ventilation (Bag)
C) Supraglottic Airways
D) Endotracheal Intubation
E) Tracheostomy

2

Supraglottic airways (SGAs)

The LARYNGEAL MASK AIRWAY (LMA) is the best known and most widely-used SGA. Secondary generation have a gastric hole.
Sit on top of the glottis (vocal cords)
Patients can breathe spontaneously.
DO NOT offer reliable protection against aspiration
PRIMARY USE:
Suitable for short procedures in fasted patients who do not require intubation
SECONDARY USE:
Useful in emergencies as a backup/rescue airway when intubation or mask ventilation is not possible.

3

Endotracheal Intubation Types

Protects Against Aspiration
1. Standard endotracheal tubes
2. The Reinforced (Armoured) ETT.
3. Pre-formed (bent) ETTs (RAE tubes)

4

Standard endotracheal tubes

GOLD STANDARD TUBE
Made of polyvinyl chloride
Placed through the vocal cords using a laryngoscope.
Has inflatable/deflatable cuff
PROVIDE PROTECTION AGAINST ASPIRATION
BEST IN SUPINE POSITION (chest&abdomen)
Patient can be ventilated or breathe spontaneously .

5

The (Reinforced) Armoured ETT

Metal wiring embedded in the wall=>more resistant to compression
Flexible; more difficult to insert use bougie.
PRIMARY USE
Used in non-standard positions (prone, lateral, beech-chair, neurosurgery, shoulder surgery)
SECONDARY USE
Used also for AWAKE NASAL FIBREOPTIC INTUBATION.

6

Pre-formed (bent) ETTs (RAE tubes)= South-facing/ Oral RAE

Easy to insert, predetermined depth
Kinks easily
Used for surgery on the face, and eye surgery

7

Pre-formed (bent) ETTs (RAE tubes)= North-facing/ Nasal RAE

Inserted through the nose
More difficult to insert
For surgery in the mouth/jaw/ dental

8

Effective/Efficient Ventilation on Machine

All these in normal patient
Tidal Volume(exp)= 6-7ml/kg
RR= 12-20bpm
pCO2= 4.5-5.5kPa(%)
SATs= 100%
other: BP (must be 20% less than baseline)

9

Laryngoscopes

Blades 3= females/ 4=males
Curved= Macintosh (placed in vallecula)
Straight= Miller (underneath epiglottis)

10

Some indications for intubation (APA)

1. PROCEDURES REQUIRING IMMOBILISATION
Thoracic and abdominal surgery
Microsurgery (e.g. retinal / neurosurgery)
2. ARTIFICIAL VENTILATION IS REQUIRED
Long complex surgeries
Respiratory failure
3. SECURING AIRWAY (N.GUR)
Shared airway
Risk for aspiration
GCS<8
Unfasted stomach
Non-supine positions

11

The Airway Trolley EMAILS

Endotracheal tubes (different sizes)
Masks (different sizes), Magill's
Ambubag/ Airways (ORO/NAS)
Introducer (gum elastic bougie)
Laryngoscopes & LMAs
Suction/ Syringe/ Strapping

12

Gum elastic bougie/introducer

Long, flexible device can be passed through glottis and the ETT advanced over it
Useful with difficult intubation.

13

Suction/YANKAUER

Connected to suction tubing and collector which is connected to wall suction under negative pressure
Commonly used to suction oral / pharyngeal secretions

14

Airways

Oropharyngeal airways (OPAs)
Nasopharyngeal Airways

15

Oropharyngeal Airways

AKA Guedel airways
Assist in opening up the airway and relieving obstruction.
Prevents tongue from covering the epiglottis and back of pharynx
Awake patients will not tolerate an OPA (gag reflex)
USED
To assist spontaneously breathing patients, or to improve mask ventilation

16

Nasopharyngeal Airways

Softer BUT Insert carefully with lubrication
Serve same function as OPAs but inserted through the nostril i.e prevent tongue from obstructing pharynx