Simple Airway Management

in Emergency Situation
Chin Lift/Head Tilt/Jaw Thrust

Ear-to-sternal-notch

Bag-Valve-mask

PEEP valves
Chin Lift/ Head Tilt /Jaw Thrust
 Initial airway assessment

Evaluating for airway obstruction or patency

Assessing for snoring, stridor

The most common cause of airway

obstruction in the breathing patient with a
reduced level of consciousness is the tongue

 The Chin-Lift Head-Tilt Maneuver

.. a maneuver that gently extends the head slightly

into the "sniffing position & lifts the tongue from
the back of the throat..

.. the most reliable method of opening the airway

when cervical spine injury is not suspected..
chin-lift
Head Tilt
 Jaw Thrust
Place fingers behind the angle of the jaw
Use thumbs to open mouth
 Basic Airway Adjuncts
Oropharyngeals
Keeps tongue from blocking oropharynx
Eases suctioning
Used with BVM
Patients without gag reflex

Nasopharyngeals
Maintains patency of oropharynx
Patients with gag reflex
Should not be used with head trauma
Nasopharyngeal airway

Conscious patient
intact gag reflex
can be inserted bilaterally
contraindicated in patients
who are anticoagulated,
have basilar skull fractures,
nasal deformities or nasal
infections, and pediatric
patients.
.
Ear-to-Sternal-Notch
Ear to sternal posisition

Ear to sternal
notch

Head elevation

Ramping
Bag-valve-mask
 Bag Valve Mask
Artificial Ventilation
Delivers > 90% oxygen
Use with airway adjuncts and/or advanced
airways
Bag
O2 Reservoir

Valve

Mask
Bag-valve-mask
 BVM Ventilation
Cornerstone in MA Most Importan airway skill
Mask Ventilation is at the heart of patient safety
Requires practice to master

During CPR
Preoxygenation & critical awaiting muscle relaxant
Between repeat laryngoscopy & if laryngoscopy Fails i:
the First Bail-Out manuever
 BVM Ventilation Require..
Patent airway
Position
Seal : proper fitting mask
Adjunct OPA/NPA
Good technique : 2 people, carefull squeeze
PPV/oxygen
MASK : the one-handed E-C CLAMP technique
Technique
Two thumbs down technique/
the Thenar Eminence (TE)

2005 AHA Guidelines :

Most effective when
provided by 2 trained &
experienced rescuers

Gerstein (2013) :
The TE facemask ventilation
grip results in improved
ventilation over the EC grip
 Bag-valve-mask (BVM) ventilation

Squeeze 1 every 5
seconds

10-12 breaths per

minute

Tidal volume 8-10

mL/kg or just
large enough to
cause chest rise
 BVM during CPR
30:2 during BLS CPR until an advance airway is placed
8-10 breaths/ minute
1 second/breath
Instrinsic respiratory drive + assist pts breaths
Tachypnea assist every few breaths
Ventilate low preesure & low volume to decrease
gastric distension
 Difficult Mask ventilation
Beard smearing a water soluble lumbicant (
K-Y jelly )
Obese : OP+NPA, 2 handed technique, reverse
trendelenberg
 Difficult Mask ventilation
Failure of bag- mask Ventilation
1. Better bag- mask Ventilation
Reposition
OP/NP airway
2 person, 2-handed technique
Change mask
2.Intubate
3.If Cant ventilate, cant intubate
- Laryngeal mask airway (LMA )
- Cricothyroidotomy
 Assesment of efficacy
Observe the chest rise and fall
Pulse oximetry
Lack of the air entering the stomach
Feeling the bag
ETCO2
 CONCLUTION
Assessing the patency and adequacy of an airway is a
critical skill in emergency and critical care medicine
Simple maneuvers and basic airway adjuncts can ensure
a patent airway and allow for effective oxygenation and
ventilation until a more definitive airway is established
Bag-valve-mask (BVM) ventilation is the most important
skill in basic airway management.
BVM ventilation requires patent airway, Position,
proper fitting mask, Adjunct , good technique &
PPV/oxygen
Use ETCO2 as an objective measurement.