airway adjuncts and management in acls
DESCRIPTION
techniques to manage airway during cardiac arrestTRANSCRIPT
ADJUNCTS FOR AIRWAY CONTROL, VENTILATION
AND SUPPLEMENTAL OXYGEN
Objectives
1. To control the airway properly during cardiac arrest
2. To optimize ventilation3. To use airway adjuncts properly and effectively4. To provide supplemental oxygen properly and
effectively
1
Open airway by
OPEN AIRWAY( Head - tilt / chin - lift / jaw - thrust )
No respirations
present
Spontaneous respirations present
VENTILATE WITH SUPPLEMENTAL OXYGENMouth-to-Mask, B-V-M
KEEP AIRWAY OPEN AND MONITOR PATIENT
INSERT PHARYNGEAL AIRWAY (oral or nasal)
VENTILATE
ENDOTRACHEAL INTUBATION(as soon as possible)
No chest expansio
n
Foreign body
obstruction
AIRWAY CONTROLAirway Obstruction
•Tongue and/or
•Epiglottis
AIRWAY CONTROLOpening the Airway
Jaw thrust Head tilt–chin lift
AIRWAY CONTROLOropharyngeal Airway
AIRWAY CONTROLOropharyngeal Airway (cont.)
AIRWAY CONTROLOropharyngeal Airway (cont.)
AIRWAY CONTROLOropharyngeal Airway (cont.)
AIRWAY CONTROLOropharyngeal Airway (cont.)
AIRWAY CONTROLNasopharyngeal Airway
AIRWAY CONTROLNasopharyngeal Airway (cont.)
AIRWAY CONTROLNasopharyngeal Airway (cont.)
ENDOTRACHEAL INTUBATION
• Protection of the airway from aspiration of foreign material
• Facilitates ventilation and oxygenation• Facilitates suctioning of trachea and
bronchi• Provides route for drug administration• Prevents gastric insufflation• Allows faster rate of chest compression
Advantages
ENDOTRACHEAL INTUBATION
• Inability to ventilate the unconscious patient
• After insertion of pharyngeal airway• Inability of patient to protect own
airway (coma, areflexia, or cardiac arrest)
• Need for prolonged artificial ventilation
Indications
ENDOTRACHEAL INTUBATION
• Laryngoscope with several blades
• Endotracheal tubes• Malleable stylet• 10-ml syringe• Magill forceps• Water soluble lubricant• Functional suction unit
Equipment
ENDOTRACHEAL INTUBATIONLaryngoscope & Blades
ENDOTRACHEAL INTUBATIONLaryngoscope (cont.)
Connection of blade to handle
ENDOTRACHEAL INTUBATIONEndotracheal tube
ENDOTRACHEAL INTUBATIONEndotracheal tube (cont.)
Stylet
Aligning Axes of Upper Airway
Extend-the-head-on-neck (“look up”): aligns axis A relative to B
Flex-the-neck-on-shoulders (“look down”): aligns axis B relative to C
C
ABA
B
C
TracheaPharynx
Mouth
ENDOTRACHEAL INTUBATION
ENDOTRACHEAL INTUBATION
ENDOTRACHEAL INTUBATION
ENDOTRACHEAL INTUBATION
ENDOTRACHEAL INTUBATION
ENDOTRACHEAL INTUBATION
• Intubate as soon as possible after ventilation and oxygenation, in cardiac arrest
• Intubation should be done by most experienced person
• Do not take longer than 30 seconds• Auscultate the thorax and
epigastrium after intubation
Recommendations
ENDOTRACHEAL INTUBATION
• Trauma-teeth, lips, tongue, mucosa, vocal cords, trachea
• Esophageal intubation• Vomiting and aspiration• Hypertension and
arrhythmias
Complications
OXYGENATION AND VENTILATION
• Elimination of direct contact• Adequate lung ventilation• Enriched oxygen mixture• Easier than bag-valve-mask
Mouth-to-mask
Advantages
OXYGENATION AND VENTILATIONMouth-to-mask (cont.)
Mouth-to-mask device
OXYGENATION AND VENTILATIONMouth-to-mask (cont.)
Technique
OXYGENATION AND VENTILATION
• Provides immediate ventilation and oxygenation
• Sense of compliance and airway resistance conveyed to operator
• Ideal method of ventilation after intubation• High oxygen concentrations are possible• Can be used with spontaneous respirations
Bag-Valve-Mask
Advantages
OXYGENATION AND VENTILATIONBag-Valve-Mask (cont.)
With oxygen reservoir
Bag-Mask Ventilation• Key—ventilation volume: “enough to produce
obvious chest rise”
1-Person: difficult, less effective
2-Person:easier, more effective
OXYGENATION AND VENTILATION
OXYGENATION AND VENTILATIONBag-Valve-Mask (cont.)
Complications
• Inadequate tidal volumes leading to hypoventilation
• Gastric distension
OXYGENATION AND VENTILATIONManually Triggered Oxygen Powered
Breathing Device
• Allow for positive pressure ventilation• Deliver 100% oxygen concentration• Should provide a constant flow at 40
L/min• Should have a relief valve that opens at
60 cmH2O
SUCTION DEVICES
TRACHEOBRONCHIAL SUCTIONING
Techniques
• Check equipment• Set pressure between –80 to –120
mmHg• Pre-oxygenate with 100% O2 for
five minutes• Use sterile technique• Insert suction catheter through the tube• Apply suction and remove the catheter
with a rotation motion• Suction no longer than 10 seconds
OTHER ADJUNCTS & TECHNIQUES
Cricoid Pressure
Esophageal-Tracheal Combitube
A = esophageal obturator; ventilation into trachea through side openings = B
C = tracheal tube; ventilation through open end if proximal end inserted in trachea
D = pharyngeal cuff; inflated through catheter = E
F = esophageal cuff; inflated through catheter = G
H = teeth marker; blindly insert Combitube until marker is at level of teeth
Distal End
Proximal End
B
C
D
E
F
G
H
A
Esophageal-Tracheal Combitube Inserted in Esophagus
A = esophageal obturator; ventilation into trachea through side openings = B
D = pharyngeal cuff (inflated)
F = inflated esophageal/tracheal cuff
H = teeth markers; insert until marker lines at level of teeth
D
A
DB F
H
Laryngeal Mask Airway (LMA)
The LMA is an adjunctive airway that consists of a tube with a cuffed mask-like projection at distal end.
LMA Introduced Through Mouth Into Pharynx
LMA in Position
Once the LMA is in position, a clear, secure airway is present.
Anatomic Detail
Esophageal Detector Device (Bulb-Type)
Confirmation: Tracheal Tube Placement
End-tidal colorimetric CO2 indicators
Tracheal Tube Holders:Adult and Infant
Colorimetric End-Tidal CO2 Detector
End-Tidal CO2 Detectorconnected to Bag-valve-mask