Airway Management

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Transcript

1. AIRWAY MANAGEMENT
2. ▸ THE HUMAN BODY NEEDS A CONSTANT SUPPLY OF OXYGEN. ▸ THE AIRWAY IS WHERE IT ALL BEGINS
3. RESPIRATORY SYSTEM ▸ Brings in oxygen ▸ Eliminates carbon dioxide
4. AIRWAY OR VENTILATION COMPROMISE = ACUTE DETERIORATION AND DEATH
5. PERMANENT DEATH OF BRAIN CELLS OCCURS AFTER APPROXIMATELY 6 MINUTES WITHOUT OXYGEN.
6. FAILURE TO MANAGE THE AIRWAY OR INAPPROPRIATE MANAGEMENT OF THE AIRWAY IS A MAJOR CAUSE OF PREVENTABLE DEATH IN THE PREHOSPITAL SETTING.
7. MORTALITY AND MORBIDITY INCREASE DUE TO: ▸ Failure to use basic airway techniques ▸ Improper performance of the techniques ▸ Rush to use advanced interventions ▸ Failure to reassess the patient’s condition
8. REVIEW OF AIRWAY ANATOMY
9. UPPER AIRWAY ▸ Consists of all anatomic airway structures above the glottic opening.
10. TONGUE ▸ Must be manipulated ▸ Tends to fall back into the posterior pharynx in unresponsive patient
11. PHARYNX ▸ Muscular tube that extends from the nose and mouth to the esophagus and trachea ▸ Composed of: ▸ Nasopharynx ▸ Oropharynx ▸ Laryngopharynx (hypopharynx)
14. DIFFICULT INTUBATION = LEMON ▸ Look externally ▸ Evaluate 3-3-2 rule ▸ Mallampati score ▸ Obsctruction ▸ Neck Mobility
16. LOWER AIRWAY ▸ Extends from the glottis to the pulmonary capillary membrane.
17. LARYNX ▸ Complex structure formed by many independent cartilaginous structures ▸ Marks where the upper airway ends and lower airway begins
18. THYROID CARTILAGE ▸ Shield-shaped structure ▸ Formed by two plates that join in a “V” shape anteriorly to form the laryngeal prominence ▸ Known as the Adam’s apple
19. CRICOID CARTILAGE (CRICOID RING) ▸ Lies inferiorly to the thyroid cartilage ▸ Forms the lowest portion of the larynx
20. CRICOTHYROID MEMBRANE ▸ Located between the thyroid and cricoid cartilage ▸ Bordered laterally and inferiorly by the highly vascular thyroid gland
21. GLOTTIS ▸ Narrowest portion of the adult airway
22. TRACHEA ▸ Immediately descends into the thoracic cavity ▸ Not a straight tube, which is key to understand when placing an ET tube
23. VENTILATION, OXYGENATION, AND RESPIRATION
24. VENTILATION 1. Physical act of moving air into and out of the lungs 2. Inhalation is the active, muscular part of breathing. 3. Exhalation is a passive process and does not normally require muscular effort.
25. OXYGENATION 1. Process of loading oxygen molecules onto hemoglobin molecules in the bloodstream 2. Requires adequate FIO 2 a. Percentage of oxygen in inhaled air
26. RESPIRATION ▸ Process of exchanging O 2 and CO 2
27. EXTERNAL RESPIRATION ▸ Also called pulmonary respiration ▸ Process of exchanging O 2 and CO 2 between the alveoli and blood in pulmonary capillaries
28. INTERNAL RESPIRATION ▸ Also called cellular respiration ▸ Exchange of O 2 and CO 2 between the systemic circulation and the body’s cells
29. HYPOXIA ▸ Tissues and cells do not receive enough oxygen ▸ Early signs include restlessness, irritability, apprehension, tachycardia, and anxiety. ▸ Late signs include mental status changes, a weak pulse, and cyanosis. ▸ Responsive patients often report dyspnea and may not be able to
30. VENTILATION- PERFUSION RATIO AND MISMATCH
31. V/Q Mismatch Video Link
32. AIR AND BLOOD FLOW MUST BE DIRECTED TO THE SAME PLACE AT THE SAME TIME ▸ Ventilation and perfusion must be matched
33. FAILURE TO MATCH VENTILATION AND PERFUSION (V/Q MISMATCH): ▸ Lies behind most abnormalities in oxygen and carbon dioxide exchange.
34. IN MOST PEOPLE, NORMAL RESTING MINUTE VENTILATION IS APPROXIMATELY 6 L/MIN. ▸ Resting alveolar volume: Approximately 4 L/min ▸ Pulmonary artery blood flow: Approximately 5 L/min ▸ Overall ratio of ventilation to perfusion: 4:5 L/min, or 0.8 L/min
35. RATIO OF VENTILATION TO PERFUSION IS HIGHEST AT THE APEX OF THE LUNG AND LOWEST AT THE BASE.
36. WHEN VENTILATION IS COMPROMISED BUT PERFUSION CONTINUES: ▸ Blood passes over alveolar membranes without gas exchange. ▸ CO 2 is recirculated into the bloodstream. ▸ Results in V/Q mismatch ▸ Could lead to severe hypoxemia if not recognized and treated
37. WHEN PERFUSION ACROSS THE ALVEOLAR MEMBRANE IS DISRUPTED: ▸ Less O 2 is absorbed into the bloodstream ▸ Less CO 2 is removed (V/Q mismatch). ▸ Can lead to hypoxemia ▸ Immediate intervention is needed to prevent further damage or death.
38. FACTORS AFFECTING VENTILATION ▸ A patent airway is critical for the provision of O2 to tissues. ▸ Intrinsic and extrinsic factors can cause airway obstruction. ▸ Intrinsic factors: infection, allergic reactions, and unresponsiveness. ▸ Extrinsic factors: trauma and foreign body airway obstruction.
39. FACTORS AFFECTING VENTILATION ▸ The tongue is the most common obstruction in an unresponsive patient. ▸ Some factors are not necessarily directly part of the respiratory system. ▸ Interruptions in the central and peripheral systems. ▸ Medications that depress the central nervous system.
40. FACTORS AFFECTING VENTILATION ▸ Neuromuscular disorders. ▸ Neuromuscular blocking agents. ▸ Allergic reactions ▸ Swelling (angio-edema) can obstruct the airway. ▸ Broncho-constriction can decrease pulmonary ventilation.
41. FACTORS AFFECTING VENTILATION ▸ Extrinsic factors: trauma and foreign body airway obstruction.
42. FACTORS AFFECTING VENTILATION - EXTRINSIC FACTORS ▸ Trauma to the airway or chest ▸ Requires immediate evaluation and intervention
43. FACTORS AFFECTING VENTILATION - EXTRINSIC FACTORS ▸ Blunt or penetrating trauma and burns ▸ Can disrupt airflow through the trachea and into the lungs ▸ Quickly results in oxygenation deficiencies
44. FACTORS AFFECTING VENTILATION - EXTRINSIC FACTORS ▸ Trauma to the chest wall ▸ Can lead to inadequate pulmonary ventilation
45. EXAMPLE: A PATIENT WITH NUMEROUS RIB FRACTURES OR A FLAIL CHEST MAY PURPOSELY BREATHE SHALLOWLY IN AN ATTEMPT TO ALLEVIATE PAIN FROM THE INJURY. ▸ Respiratory splinting ▸ Can result in decreased pulmonary ventilation ▸ Proper ventilatory support is crucial.
46. HYPERVENTILATION OCCURS WHEN CARBON DIOXIDE ELIMINATION EXCEEDS CARBON DIOXIDE PRODUCTION.
47. HYPOVENTILATION AND HYPERVENTILATION COULD REPRESENT THE BODY’S ATTEMPT TO COMPENSATE FOR VARIOUS ABNORMAL CONDITIONS.
48. Difficult LMA = RODS ▸ Restricted mouth opening ▸ Obstruction ▸ Distorted airway ▸ Stiff lungs or c-spine
49. Difficult BVM = BONES Beard Obese No teeth Elderly Sleep Apnea / Snoring
50. Difficult surgical airway = SHORT Surgery Hematoma Obesity Radiation distortion or other deformity Tumor
51. MALLAMPATI SCORE ▸ Class I: Soft palate, uvula, fauces, pillars visible ▸ Class II: Soft palate, uvula, fauces visible ▸ Class III: Soft palate, base of uvula visible ▸ Class IV: Only hard palate visible
52. (EMCrit EVLI Intubation Video Link)[https://youtu.be/5zHYNqG2Wvk]