Flashcards in Airway Equipment and Management Deck (16)
Types of Airway Support
A) Spontaneous Ventilation
B) Mask ventilation (Bag)
C) Supraglottic Airways
D) Endotracheal Intubation
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
Suitable for short procedures in fasted patients who do not require intubation
Useful in emergencies as a backup/rescue airway when intubation or mask ventilation is not possible.
Endotracheal Intubation Types
Protects Against Aspiration
1. Standard endotracheal tubes
2. The Reinforced (Armoured) ETT.
3. Pre-formed (bent) ETTs (RAE tubes)
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 .
The (Reinforced) Armoured ETT
Metal wiring embedded in the wall=>more resistant to compression
Flexible; more difficult to insert use bougie.
Used in non-standard positions (prone, lateral, beech-chair, neurosurgery, shoulder surgery)
Used also for AWAKE NASAL FIBREOPTIC INTUBATION.
Pre-formed (bent) ETTs (RAE tubes)= South-facing/ Oral RAE
Easy to insert, predetermined depth
Used for surgery on the face, and eye surgery
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
Effective/Efficient Ventilation on Machine
All these in normal patient
Tidal Volume(exp)= 6-7ml/kg
other: BP (must be 20% less than baseline)
Blades 3= females/ 4=males
Curved= Macintosh (placed in vallecula)
Straight= Miller (underneath epiglottis)
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
3. SECURING AIRWAY (N.GUR)
Risk for aspiration
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
Gum elastic bougie/introducer
Long, flexible device can be passed through glottis and the ETT advanced over it
Useful with difficult intubation.
Connected to suction tubing and collector which is connected to wall suction under negative pressure
Commonly used to suction oral / pharyngeal secretions
Oropharyngeal airways (OPAs)
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)
To assist spontaneously breathing patients, or to improve mask ventilation