AIRWAY MANAGEMENT
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Transcript of AIRWAY MANAGEMENT
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Respiratory Problems
are the most common cause of
Pediatric ArrestWanida PaoinThammasat
Hospital,Thammasat University
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๐Airway๐ positioning, opening๐ oro/nasopharyngeal airway
๐Breathing๐ mouth to mouth (+ nose) ๐ bag-mask๐ laryngeal mask๐ endotracheal intubation
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Airway Anatomy & Physiology
Large tongueHigh glottis
Slanting vocal cord
Narrow cricoid ring
C4
C7
Narrower nares
Large occiputImmature laryngeal reflex
ทำ��ไมเด็กจึ�งห�ยใจึทำ�งจึม�กได็�ด็�กว่��ทำ�งป�ก ทำ��ไมจึ�งต้�องใช้� straight blade ในก�รใส่� ET tube ในเด็กอ�ย�น�อยกว่�� 2 ป� ทำ��ไม ET tube ในเด็กทำ�รกจึ�งเลื่ !อนหลื่�ด็ได็�ง��ย ทำ��ไมจึ�งส่�ม�รถใส่� ET tube ในเด็กทำ�รกได็�ง��ยขณะเด็กต้ !น ทำ��ไมจึ�งเลื่ อกใช้� uncuff-tube ในเด็กอ�ย�น�อยกว่�� 8 ป�
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Airway Anatomy & Physiology
Loose tissue
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Airway Anatomy & Physiology
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• Position• Open the airway
– - head tilt chin lift maneuver– - jaw thrust maneuver– oropharyngeal and nasopharyngeal airway– - foreign body airway obstruction
Airway
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head tilt-chin lift jaw-thrust
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Oropharyngeal Airway
Nasopharyngeal Airway
Indication
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Breathing•Assessment• Provide rescue breathing
–mouth-to-mouth-and-nose and mouth-to mouth– - bag mask ventilation– laryngeal mask airway– endotracheal intubation– ventilation through a tracheostomy or stoma
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self inflatingsize > 450-500 ml.
“E-C clamp
gastric inflation cricoid pressure
visible chest risingavoid excessive ventilation
reservoirO 2 flow > - 10 15 L/min
O2
-conc. 60 95%opening the airway
appropriately sized mask
B - ag mask ventilation
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• used in unconscious patient• contraindicted in a patient w
ith an intact gag reflex• eqivalent ventilation compar
e with ET tube• uncommom aspiration• more difficult to maintain th
an ET tube
Laryngeal Mask Airway
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Laryngeal Mask Airway
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•Advantages• Indications•Equipment•Procedure•Verification of proper
tube placement
Endotracheal Intubation
3 tracheal tube: cuff or uncuffsuction catheteroxygen sourceface maskself-inflating bag + PEEP valvestyletlubricantlaryngoscope blade and handleexhaled CO2 detectortape and equipment to immobilize
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uncuffed tube: tracheal tube size (mm) = age in years + 4 4
cuffed tube: tracheal tube size (mm) = age in years + 3
4
Endotracheal tube size
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•Advantages• Indications•Equipment•Procedure•Verification of proper
tube placement
Endotracheal Intubation
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Displacemant
Deteriorating condition of an intubated patient
EquipmentfailurePneumothorax
Obstruction
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๐Airway๐ positioning, opening๐ oro/nasopharyngeal airway
๐Breathing๐ mouth to mouth (+ nose) ๐ bag-mask๐ laryngeal mask๐ endotracheal intubation