Airway Obstruction and Management

Dr. Riaz Ahmed KhanAssociate Professor and Head Department of AnaesthesiologyRehman Medical Institute

What is an Airway?

• Your 1st Year Knowledge of Physiology?

• The path air follows to get into and out of the lungs.

• The mouth and nose are the normal entry and exit ports.

• Entering air then passes through the back of the throat (pharynx), continues through the voice box (larynx), down the trachea, and finally out the branching tubes known as bronchi.

Respiratory Anatomy

Respiratory Physiology

What will you do with the Injured Person Here?

ATLS (Advanced Trauma Life Support)

• Performed in an injured / trauma patient

• Starts as BTLS on site of injury

• Consists of the following components:

1. Airway

2. Breathing

3. Circulation

• We will only discuss the AIRWAY part of the trauma protocol.

What is Airway Obstruction?

• Any obstacle from Mouth to Lungs• May be Partial or Complete• Limitation of air entry into Lungs • Causing Lack of O2 Inflow or CO2

Outflow• Relieving obstruction is very important

for LIFE!

Why is it Important to Maintain Airway?

• Sensitive organs like brain and heart can die within a few minutes without O2

• Patient becomes unconscious (hypoxia and hypercarbia) further risk of Aspiration

• Trauma patient Airway comes FIRST

• Crucial few minutes

AIRWAY RESCUE METHODS1) MANUAL MANOEUVRES: • Mostly done at site, also in ambulance• Head tilt, chin lift, jaw thrust• Clearing mouth with hooked finger

2) INSTRUMENTATION:• If above unsuccessful, mostly ambulance/hospital facility• Various artificial airways like Ambu Bag, Oropharyngeal

and Nasopharyngeal Airway, Endotracheal Tube, Laryngeal Mask Airway

3) SURGICAL AIRWAY:• If 2nd Option unsuccessful, almost always in hospital• Surgical Creation/Bypass of Airway • Anatomical Landmarks Important• Only skilled professional should attempt• Includes Cricothyroidotomy and Tracheostomy.

MANUAL MANOEUVRES

See for Any Response / Call Name Call for Help / Ambulance

MANUAL MANOEUVRES (cont….)

Head Tilt and Chin Lift (Opens the Oral Airway if Tongue Obstruction)

MANUAL MANOEUVRES (cont….)Hear for Breathing, see chest movements If NO then start Mouth to Mouth Breaths, but Nose must be pinched to Avoid Leakage of Air

MANUAL MANOEUVRES (cont….)LATERAL LYING POSITION FOR A BREATHING UNCONSCIOUS PATIENT

Artificial Airways

AMBU Bag and Procedure (Remember to do Head Tilt and Chin Lift to Open the Airway otherwise Bagging will be Ineffective)

Artificial Airways (cont…)Oropharyngeal Airway (Guedel Airway)

Artificial Airways (cont…)

Nasopharyngeal Airway

Artificial Airways (cont…)

Laryngeal Mask Airway

Artificial Airways (cont…)Laryngoscope with Various Sizes of Blades (Left Picture) Used to Intubate Endotracheal Tube with Cuff (Right Picture)

Artificial Airways (cont…)

Laryngoscopic View of Epiglottis and Glottis (Laryngeal Opening) and Endotracheal Tube In Place