Airway Management
Airway Management
 

Advanced Airway Interventions

 
 
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Bag-Valve-Mask

  • The bag-valve-mask system is a self-inflating device that is able to deliver high-flow oxygen, expiratory pressure and inspiratory pressure.
  • A bag-valve-mask system may be used with an oropharyngeal or nasopharyngeal airway in situ, to aid in opening the airway.

Intubation

  • If the patient requires intubation, this should be performed by a highly trained member of staff with appropriate planning, monitoring and pre-medication.
    • Indications for Intubation

    • Airway

    • Inability to maintain airway patency (upper airway obstruction) - soft tissue swelling, deformity, obesity, tongue displacement
    • Inability to protect the airway - sedation (e.g. for procedures), upper airway bleeding, excessive secretions
    • Breathing

    • Inability to ventilate - unconsciousness, sedation, neuromuscular disease, exhaustion
    • Inability to oxygenate - severe acute respiratory failure
    • Circulation

    • Cardiac arrest
    • Complications of Intubation

    • During Insertion

    • Incorrect placement - oesophagus / bronchus
    • Trauma - teeth / oral cavity / pharynx / larynx / trachea
    • Hypoxia (due to delayed intubation)
    • While Intubated

    • Mechanical issues - tube obstruction / kinking, loss of cuff integrity
    • Infection - ventilator-associated pneumonia
    • Self extubation
    • After Extubation

    • Sore throat
    • Laryngeal / tracheal pathology - oedema, spasm, stenosis
    • Vocal cord paralysis

Cricothyroidotomy

  • Cricothyroidotomy can be considered as an emergency airway technique in a patient with a difficult airway. This should be performed by an experienced operator with appropriate equipment and staff available.
Last updated on March 25th, 2020
 
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