AIRWAY MANAGEMENT AND VENTILATION

Prof.Dr. Koeshartono, SpAn K.IC. PGD.Pall.Med (ECU) Bag / SMF Anestesiologi & Reanimasi ( Kedokteran Gawat Darurat ) FK. Unair - RSU Dr. Soetomo Surabaya

At the completion of the course

I. The student will be able to :
1. 2. Identify persons who require airway control Define adequate minute volume Oxygenation Explain their importance As they related to trauma patients Define reduced perfusion Explain the need for increased oxygenation and tidal volume exchange in trauma patients List methods of manual & mechanical airway management and their correct application techniques while maintaining in line cervical spine immobilization

3. 4.

5.

At the completion of the course

II. The student will be able to :
6. List methods of ventilation and their correct application techniques while maintaining in line cervical spine immobilization List common errors encountered with bag valve mask ventilation List the indication, methods and common errors of percutaneous, transtracheal ventilation endotracheal intubation and need thoracotomy Define the technique for reassessing the result of the airway and ventilation effort on the trauma patient

7. 8.

9.

III. Upper Airway

The airway system an open path that leads atmospheric air through the nose, mouth and bronchi to the alveoli Each breath takes 1,2 liters of air Dead space 250 cc it is not available to the body to be used for oxygenation

IV. Patients Airway

The respiratory system is composed of an upper & lower airway some of air that passes into the nose is contained within the Pharynx Larynx Trachea Bronchi And thus does not reach the alveoli This is known as dead space

V. Upper Portion of the Airway

The upper airway Nasal cavity pharynx Oral caavity naso, oro, hypo Nasal cavity Warming Humidifying Filtering Below the pharynx Esophagus trachea The next Stomach Lower airway

VI. The first portion of the trachea Larynx which contains The vocal cord & muscles Vestibular fold Arytenoid cartilage Epiglottis acting a gate air into the trachea solids & liquids into the esophagus

VII. Lower Portion of the Airway

Lower airway Right & left main stem bronchus Primary, secondary, tertiary bronchi Broncholes = very small bronchial tubes Alveoli :
Tiny air sacs Surrounded by capillaries Resp. syst meets circ syst. gas exchange occurs

VIII. Physiology

Oxygen moves into the red blood cells from the alveoli They are transferred to the cell on the hemoglobin molecule After leaving the hemoglobin molecule the oxygen travels into the tissue cell Carbondioxide travels in the reverse direction but not on the hemoglobin molecule It travels both in the plasma and in the red blood cell it self as carbondioxide

IX. Gas Exchange

Gas exchanging process oxygen is exchanged with carbondioxide is known pulmonary diffusion Oxygenated red blood cell deliver their oxygen which the cell then use it, carbondioxide is the released into the blood plasma this process is called celluler perfusion Ventilation is essential for the elimination of carbondioxide The size of each breath = tidal volume
The minute volume If the minute volume should Fall below normal = hypoventilation

X. Trauma Impact Trauma can effect the resp. systs ability in six ways 1. Decreased neurologic function 2. Obstruction of the airway 3. Decreased expansion of the lung 4. Decreased absorption of oxygen across the A-C membrane 5. Decreased blood flow to the alveoli 6. Inability of the air to reach the alveoli

XI. Airway and Ventilation Management

Mechanical airway obstructions Airway Control Manual Mechanical Transtracheal Suctioning Oxygenation & ventilation

XII. Ventilatory Devices

Masks Bag Valve Mask (BVM) Manualy triggered (oxygen powered) devices