Anatomy of the Upper Airway

Anatomy of the Upper Airway

Sinuses
cavities formed by cranial bones act as tributaries for fluid to & from eustachian tubes & tear ducts trap bacteria, commonly infected

Anatomy of the Upper Airway

Anatomy of the Upper Airway

From: CPEM, TRIPP, 1998

Anatomy of the Upper Airway

Anatomy of the Lower Airway

Anatomy of the Lower Airway

Occlusion of the bronchiole
Smooth muscle Foreign body (not shown) Inflammation

Lung Volumes & Capacities

Ventilation

Ventilation
mixture
Atmospheric
Nitrogen 597.0 torr (78.62%); Oxygen 159.0 torr (20.84%); Carbon Dioxide 0.3 torr (0.04%); Water 3.7 torr (0.5%)

Anatomy of the Lower Airway

Inspired Air: PO2 160 & PCO2 0.3

End-Tidal CO2 Monitoring Laboratory Testing ofcirculation - PO2 100 PO2 40 & PCO2 46 - Pulmonary Blood
Arterial Venous
Deoxygenated

Alveoli PO2 100 & PCO2 40

& PCO2 40

Heart

Oxygenated

PO2 40 & PCO2 46 - Systemic circulation - PO2 100 & PCO2 40 Tissue cell PO2 <40 & PCO2 >46

Equipment Review

From AHA PALS

Airway & Ventilation Methods: ALS

Airway & Ventilation Methods: ALS

Patient Positioning
Goal
Align the 3 planes of view, so that The vocal cords are most visible

T - trachea P - Pharynx O - Oropharynx

From AHA PALS

Airway & Ventilation Methods: ALS

Assessing the Possibility of Difficulty in Intubation
Difficulty

Airway & Ventilation Methods: ALS

What effect would the angle of the mandible have on intubation difficulty?

Airway & Ventilation Methods: ALS

Curved (Macintosh) Blade
Visualize anatomy Insert from right to left Lift upward and away Blade in vallecula Lift epiglottis indirectly
From AHA ACLS

Airway & Ventilation Methods: ALS

Straight (Miller) Blade
Visualize anatomy Insert from right to left moving tongue away Lift upward and away Blade past vallecula and over epiglottis Lift epiglottis directly
From AHA ACLS

Tube Positioning

From TRIPP, CPEM

Airway & Ventilation Methods: ALS

Digital Intubation

Airway & Ventilation Methods: ALS

Jet Ventilation
Usually requires highpressure equipment Ventilate 1 sec then allow 3-5 sec pause Hypercarbia likely Temporary: 20-30 mins High risk for barotrauma

Airway & Ventilation Methods: BLS & ALS

Pharyngeal Tracheal Lumen Airway (PTLA)

Airway & Ventilation Methods: BLS & ALS

Combitube
2 . No
. No 2
No. 1

No . 2 15 ml

No. 1 100 ml

No. 1

No .2 15 ml

No. 1 100 ml

Airway & Ventilation Methods: BLS & ALS

Laryngeal Mask Airway (LMA)
Use in OR Gaining use in outof-hospital Not useful with high airway pressure Not a replacement for ETT Multiple models & sizes

LMA

Airway & Ventilation Methods: BLS & ALS

Esophageal Gastric Tube Airway (EGTA)

Airway & Ventilation Methods: BLS & ALS

Airway & Ventilation Methods: ALS

Airway & Ventilation Methods: ALS

Airway & Ventilation Methods: ALS

Examples of Secondary Tube Placement Confirmation Devices