Advanced Life Support

AIRWAY MANAGEMENT AND VENTILATION

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Advanced Life Support

Airway management & ventilation Objective

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Basic airway management and ventilation The laryngeal mask airway and Combitube Advanced techniques of airway management

Advanced Life Support Common causes of airway obstruction Upper Airway tongue soft tissue oedema, foreign material blood, vomit Larynx laryngospasm, foreign material Lower Airway secretions, oedema, blood bronchospasm aspiration of gastric contents

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Advanced Life Support Recognition of airway obstruction LOOK for chest/abdominal movement LISTEN at mouth and nose for breath sounds, snoring, gurgling
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FEEL

at mouth and nose for expired air

Advanced Life Support Opening the airway

Head tilt Chin lift Jaw thrust

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CAUTION! cervical spine injury

Advanced Life Support Head Tilt and Chin Lift

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Advanced Life Support Jaw Thrust

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Advanced Life Support Suction

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Advanced Life Support

Simple airway adjuncts

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Advanced Life Support Oropharyngeal Airway

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Advanced Life Support Nasopharyngeal Airway

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Advanced Life Support Mouth to mask ventilation

Advantages: Avoids direct person to person contact Decreases potential for cross infection Allows oxygen enrichment
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Limitations: Maintenance of airtight seal Gastric inflation

Advanced Life Support Bag-valve-mask, 2-person ventilation

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Advanced Life Support Ventilation using self inflating bag

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Advantages Avoids direct person to person contact Allows oxygen supplementation up to 85% Can be used with facemask, LMA, Combitube, tracheal tube

Advanced Life Support Ventilation using self inflating bag

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Limitations When used with a facemask: Risk of inadequate ventilation Risk of gastric inflation Need two persons for optimal use

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Advanced Life Support

Advanced Airway Management

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Advanced Life Support The Laryngeal Mask Airway

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Advanced Life Support The Laryngeal Mask Airway

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Advantages Rapidly and easily inserted Variety of sizes More efficient ventilation than facemask Avoids the need for laryngoscopy

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Advanced Life Support The Laryngeal Mask Airway

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Limitations No absolute guarantee against aspiration Not suitable if very high inflation pressures needed Unable to aspirate airway

Advanced Life Support The Laryngeal Mask Airway

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Fig 2
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Advanced Life Support The Laryngeal Mask Airway

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Advanced Life Support

The Combitube

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Advanced Life Support The Combitube

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Advanced Life Support The Combitube

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Advantages Rapidly and easily inserted Avoids need for laryngoscopy Protects against aspiration Can be used if inflation pressures high

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Advanced Life Support The Combitube

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Limitations Available in 2 sizes only Potential for ventilation via wrong lumen Damage to cuffs on insertion Trauma on insertion Single use

Advanced Life Support The Combitube

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Advanced Life Support

Tracheal Intubation

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Advanced Life Support Tracheal Intubation

Advantages Allows ventilation with up to 100% O2 Isolates airway, preventing aspiration Allows aspiration of the airway Alternative route for drug administration

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Advanced Life Support Tracheal Intubation

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Limitations Training and experience essential Failed insertion, oesophageal placement Potential to worsen cervical cord or head injury

Advanced Life Support Needle Cricothyroidotomy

Indication Failure to provide an airway by any other means Complications Malposition of cannula Emphysema Haemorrhage Oesophageal perforation Hypoventilation Barotrauma

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Advanced Life Support

Any Questions?
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Advanced Life Support Summary

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Recognise and relieve airway obstruction using basic techniques Oxygen The role of the LMA, Combitube and tracheal intubation in managing the airway during CPR

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