Definitive Airway Management

in Trauma and Emergency

Cases
Curriculum Vitae
 3

Dr. dr. Djayanti Sari, M.Kes, SpAn-KAP

4
 5

CASE
 6

INTRODUCTION
Emergency Airway Management : Unique Considerations
• Full stomach - high aspiration risk
• Altered level of consciousness
• Deteriorating cardiorespiratory physiology - (hypotension, hypoxia)
• Abnormal or distorted upper airway anatomy
• No time for “pre-op” assessment
7
 8

What Is Definitive Airway Management?

Defined: a tube placed in the trachea with cuff inflated below the vocal
cords
• Oro tracheal
• Naso tracheal
• Surgical
 9

Three Pillars of Airway Management:

(Assessment of Compromises or Threats)
10
 11

Airway Management
 12

Prevention?

1. Assesment: anatomy, other airway difficulties

2. Good technique Plan
3. Preparation (difficult airway kit)
4. Practice
 13

Airway Anatomy

UPPER AIRWAY

LOWER AIRWAY
14
 15

Predictor
• Lemon
• Intubation
• • Look externally
• • Edentulous
• • Mallampati •
• Obstruction Short
• Neck mobility • Cricotiroidetomy :
• • Surgery/ airway disruption
•
• Hematoma/ mass
• Obstruction
• Restriction/ deformity
• Tumor
16
 17

Endotracheal Intubation
 18

Advanced Airway Management

LMA
COMBITUBE
CRICOTIROIDOSTOMI
RETROGRADE
FIBREOPTIC
LIGHT WAND
BOUGIE
 19

…Video LMA insertion

 20

2. Combitube
 21

Combitube
 22

3. Needle Cricotiroidostomy
 23

Needle Ventilation

• Equipment:
• Spuit with hole
• Spuit with saline
filling
• Connector ETT
• Bag Mask
• O2 supply if
avaialable
 24

Tracheostomy
 25

Retrograde Intubation
 26

Fiber Optic Intubation

 27

Light Wand Intubation

 28

Bougie Intubation
 29

Camera Intubation
PDT
30

Percutaneous Dilatation Tracheostomy

 31

Complication of Emergency Surgical Airway Procedure

 32

TERIMA KASIH
 33

1. Simple
Algorithm
 34

2. Unanticipated before:
During routine induction of
anaesthesia in an adult patient
 35

3. Unanticipated
before:
During rapid sequence induction of
anaesthesia in non-obstetric adult
patient