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8/2/2019 Advance Airway Mx
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Advance airway Mx
8/2/2019 Advance Airway Mx
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1) Laryngeal mask airway (LMA)
2) Esophageal-tracheal combitube
May provide superior ventilation compare
bag mask ventilation in victim of cardiac
arrest Health care provider should complete initial
training &maintain their knowledge& skill
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Bag-mask ventilation is difficult to performeffectively (esp. by lone rescuer)
But remains single most important skill in airway
mx It is difficult to learn tracheal intubation
&maintain high level of skill without frequentuse &refresher training
Tracheal intubation is much more dangerousintervention
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Laryngeal mask airway (LMA)
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Laryngeal mask airway (LMA)
Is a adjunctive airway device compose of a
tube with a cuffed-mask like projection at the
distal end
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Insertion technique
LMA introduce into the pharyx and is blindlyadvance until resistant is felt
Resistance indicates that the distal end of the tube
has reached the hypopharynx The inflate the cuff of the mask
This pushes the mask up against the trachealopening; providing an effective seal
Ventilation occurs through the opening in thecenter of the mask
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Indication
Are the same as those for the tracheal tube
and combitube;
Inability of rescuer to ventilate the unresponsive
patient with less invasive methods.
Inability of patient to protect his/her airway (eg
coma, absent reflexes, cardiac arrest)
Continuing cardiac arrest with continuing need forcardiac compressions
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Evidence
Insertion: Successful insertion rate :64%-100%
Ventilation : Provide more secure and reliable means of ventilation than facemask
Ventilation achieved is equivalent with tracheal tube
Airway protection Regurgitation is less likely(than with the bag-mask) and aspiration is
uncommon
Patient access Advantage over tracheal tube when access to patient is limited /
positioning of patient (for tracheal intubation) is impossible Training
Simpler than tracheal intubation (because skilled laryngoscopy for thepurpose of cord visualization is not necessary)
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Esophageal-tracheal combitube
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Invasive double lumen airway device with 2
inflatable balloon cuffs. 1. lumen contain ventilating side holes at the
hyphopharyngeal level& is closed at the end
2.Open end
Inserted without visualization of vocal cord
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Insertion technique
Advance the tube blindly until the 2 marks
printed on the tube are located at the patients
teeth then inflate pharyngeal(proximal) and
esophageal(distal) balloons; isolating theoropharynx above the upper balloon and the
esophagus(or trachea) below the lower balloon.
Asses the location of the distal orifice and thenventilate patient through appropriate lumen.
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Following blind insertion, the tip of combitubemost frequently rests in esophagus, althoughtracheal intubation may occur;
If the tip of tube (and orifice) lie within the trachea,the tracheal tube (the shorter white or light lumen) isuse for ventilation directly into the trachea
If the tips of tube (and the orifice) lie withinesophagus, the esophageal obdurator end is used todeliver ventilation from the side opening of the tube.
The combitube has no stylet in the distal lumen &immediate suctioning of gastric content is possible
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Indication
Are the same as those for tracheal tube; Inability of rescuer to ventilate the unresponsive
patient with less invasive methods.
Inability of patient to protect his/her airway (eg coma,
absent reflexes, cardiac arrest) Continuing cardiac arrest with continuing need for
cardiac compressions
Advantage over the facemask;
Isolates the airway Reduces risk of aspiration
Provides more reliable ventilation
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Advantage over the tracheal tube;
Less difficult to learn and acquire skill in the
technique
Supports more effective and efficient skills
maintenance
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Complication
Esophageal trauma
Subcutaneous emphysema
Providers should receive adequate training
and practice using the devise regularly.