The airway
Ed Burdett
23 July 2011
What is an airway?
A conduit between the lungs and
the outside world
The airway always comes first
A
B
C
D
Airway management:
• Oxygenation
• Ventilation
• Airway protection
Need for airway
protection
Airway assessment
Airway plan!
My skills and
resources
What if it goes
wrong?!
This talk…
• Anatomy
• Assessment
• Managing the airway
• Indications for interventions
• Scenarios
Anatomy
Airway anatomy is important
Airway assessment
• Look
• Listen
• Feel
• (Tests)
Pragmatic
approach: what
needs to be done to
the airway?
Airway
assessment
Need for airway
protection
Airway plan!
My skills and
resources
What if it goes
wrong?!
Airway assessment - look
• Will a mask create a good seal?
• Appearance/teeth/beard
• Mouth opening - Mallampatti
• Thyromental distance and neck movement
Look
Mallampatti
Listen
• Talking
• Breathing
– Stridor - extrathoracic
– Respiratory distress
– Wheeze - intrathoracic
Feel
• Radiotherapy
• Burns
• Back of neck
Tests
Abnormal anatomy
Abnormal anatomy
Maintaining the airway
Goal: adequate oxygenation, ventilation, protection
Need for
airway
protection
Airway assessment
Airway plan!
My skills and
resources
What if it goes
wrong?!
(How) do you need to manage the
airway?
Chin lift, jaw thrust
Airway adjuncts
Measuring
Adult male
Adult female
Other ways to maintain the airway
LMA
• Easy
• Non-traumatic
• Effective
• Stops airway soiling
but not aspiration
Laryngeal mask insertion
The secure airway is a cuffed tube in the
trachea
Direct laryngsocopy
Macintosh >95% success
?
“Rapid sequence induction”
• Intubation with maximal airway protection
• For those at risk of aspiration
– Full stomach
– Acute abdomen
– Systemically unwell
– Preoxygentation/quick onset drugs/cricoid pressure
Indications for airway management
• Oxygenation
• Ventilation
• Airway protection
Need for airway
protection
Airway assessment
Airway plan!
My skills and
resources
What if it goes
wrong?!
Need for airway
protection
Airway assessment
Airway plan!
My skills and
resources
What if it goes
wrong?!
Making an airway plan
Context
Elective or emergency
Theatre/A&E/ICU
Patient status/surgical plan
Airway assessment
How easy is my plan going to be?
What to do if it goes wrong?
Example airway plan: elective
hernia repair, healthy 30 yo.
• Plan A – Elective induction, Laryngeal mask
• Plan B – Face mask ventilation +/- Guedel
• Plan C – Call for senior help, wake up
Case study 1
• You’re asked to assess Mrs Smith for a
laparotomy
• What else do you need to know?
• How do you plan to secure her airway?
• How will you asses her airway?
Case study 2
• You’re asked to come quickly to A&E because
‘there’s an unwell lady who needs to be
intubated’
• What else do you need to know?
• How do you plan to secure her airway?
• How will you asses the airway?
Common misunderstandings
“Can we have an anaesthetist to come and intubate
someone in A&E?”
“This kid’s only had sweets…can’t we do his operation
now?”
“This man has stridor and is blue but his sats are 95%
on 15L, so he’s OK, isn’t he?”
In conclusion, plan first so that
performance goes well!
“If you don’t know
where you are going,
any road will get you
there…”
Lewis Carroll