Airway management. Dr. Dóra Ujvárosy Medical Unversity of Debrecen Emergency Department

Transcription

1 Airway management Dr. Dóra Ujvárosy Medical Unversity of Debrecen Emergency Department

2 Airway management Airway management is the medical process of ensuring there is an open pathway between a patient s lungs and the outside world, as well as reducing the risk of aspiration. Airway management is a primary consideration in cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid.

3 The goal of airway management Treatment goals in airway management of a patient in the pre-hospital environment include: ensuring adequate oxygenation and safe timely transport to the appropriate care facility.

4 The ABCDE approach Primary survey using ABCDE ABCDE assessment looking for immediately life threatening conditions Rapid intervention usually includes max Should take no longer than 5 min Can be repeated as many times as necessary Get experienced help as soon as you need it If you have a team delegate jobs

5 The ABCDE approach

6 A: Airway In the unresponsive victim muscle tone is often impaired, resulting the obstruction of the pharynx by the base of the tongue and soft tissues of the pharynx. The tongue is the most common cause of airway obstruction in the unconscious victim.

7 Sometimes it is not easy

8 Basic airway management There are two maneuvers that may improve the patency of an airway obstructed by the tongue or other upper airway structures: head tilt- chin lift jaw thrust.

9 The head-tilt maneuver The rescuer s hand is placed on the patient s forehead and the head gently tilted back.

10 The head-tilt/chin-lift maneuver The rescuer s hand is placed on the patient s forehead and the head gently tilted back; the fingertips of the other hand are placed under the point of the patient s chin, which is gently lifted to stretch the anterior neck structures.

11 The jaw-thrust maneuver The rescuer s index and other fingers are placed behind the angle of the mandible, and pressure is applied upwards and forwards. Using the thumbs, the mouth is opened slightly by downward displacement of the chin. (Fatiguing and technically difficult)

12 The jaw-thrust maneuver

13 Airway management in patients with suspected cervical spine injury If spinal injury is suspected (e.g., if the victim has fallen, been struck on the head or neck, or has been rescued after diving into shallow water), maintain the head, neck, chest and lumbar region in the neutral position during resuscitation. (Excessive head tilt could aggravate the injury and damage the cervical spinal cord) When there is a risk of cervical spine injury, establish a clear upper airway by using jaw thrust or chin lift in combination with manual in-line stabilisation (MILS) of the head and neck by an assistant.

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15 Recovery position When circulation and breathing have been restored (or present from the beginning of treatment), it is important to maintain a good airway and ensure that the tongue does not cause obstruction. It is also important to minimize the risk of inhalation/aspiration of gastric contents. For this reason the unconscious victim should be placed in the recovery position. This allows the tongue to fall forward, keeping the airway clear.

16 Recovery position

17 Recovery position

18 Recovery position

19 If the victim has to be kept in the recovery position for more than 30 min turn him to the opposite side to relieve the pressure on the lower arm. Recovery position

20 Recovery position

21 Foreign-body airway obstruction (choking) Obstruction of the airway may be partial or complete. It may occur at any level, from the nose and mouth down to the trachea. In the unconscious patient, the commonest site of airway obstruction is at the level of the pharynx. Obstruction may be caused also by vomit or blood (regurgitation of gastric contents or trauma), or by foreign bodies. Laryngeal obstruction may be caused by oedema from burns, inflammation or anaphylaxis. Upper airway stimulation may cause laryngeal spasm.

22 Causes of airway obstruction

23 Symptoms of airway obstruction Grasping of the throat Anxious and distressed Difficulty in speaking and breathing Persistent cough Pale grey/blue skin developing Becoming unconscious

24 Recognition of airway obstruction The look, listen and feel approach is a simple, systematic method of detecting airway obstruction. Look for chest and abdominal movements. Listen and feel for airflow at the mouth and nose.

25 In partial airway obstruction, air entry is diminished and usually noisy. Inspiratory stridor is caused by obstruction at the laryngeal level or above. Expiratory wheeze implies obstruction of the lower airways, which tend to collapse and obstruct during expiration. Other characteristic sounds include the following: Gurgling is caused by liquid or semisolid foreign material in the main airways. Snoring arises when the pharynx is partially occluded by the soft palate or epiglottis. Crowing is the sound of laryngeal spasm.

26 Foreign bodies may cause either mild or severe airway obstruction. It is important to ask the conscious victim: Are you choking?

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28 Adult FBAO (choking) sequence 1.) If the victim shows signs of mild airway obstruction: - encourage him to continue coughing but do nothing else 2.) If the victim shows signs of severe airway obstruction and is conscious: - apply up to five back slaps as follows. Stand to the side and slightly behind the victim. Support the chest with one hand and lean the victim well forwards so that when the obstructing object is dislodged it comes out of the mouth rather than goes further down the airway. Give up to five sharp blows between the shoulder blades with the heel of your other hand

29 If five back blows fail to relieve the airway obstruction, give up to five abdominal thrusts as follows: Stand behind the victim and put both arms round the upper part of his abdomen. Lean the victim forwards. Clench your fist and place it between the umbilicus and xiphisternum. Grasp this hand with your other hand and pull sharply inwards and upwards. Repeat up to five times.

30 3.) If the victim at any time becomes unconscious. Support the victim carefully to the ground. Immediately activate EMS. Begin CPR.

31 The finger sweep No studies have evaluated the routine use of a finger sweep to clear the airway in the absence of visible airway obstruction, therefore, avoid use of a blind finger sweep and manually remove solid material in the airway only if it can be seen.

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33 Summary

34 Thank you for your attention!