of 43/43
Pediatric Airwa Management Dr.Indra Saputra SpA

Airway Management

  • View
    214

  • Download
    0

Embed Size (px)

DESCRIPTION

manajemen jalan napas

Text of Airway Management

  • Pediatric Airway ManagementDr.Indra Saputra SpA

    I.S.MD

    EarlyDefibrillationAdult Chain of SurvivalCPRALSEMS

    I.S.MD

    Pediatric Chain of SurvivalPreventionALSCPREMS

    I.S.MD

    Out-of-Hospital Cardiac ArrestSIDSTraumaSubmersionPoisoning

    ChokingSevere AsthmaPneumonia

    I.S.MD

    In-Hospital Cardiac ArrestSepsisRespiratory FailureDrug Toxicity

    Metabolic DisorderArrhythmias

    I.S.MD

    Pediatric Cardiorespiratory Arrests10%10%80%

    I.S.MD

    Hypoxia and HypercarbiaBradycardiaPediatric Cardiorespiratory Arrests

    I.S.MD

    Pediatric Chain of SurvivalPreventionALSCPREMS

    I.S.MD

    Respiratory DistressRespiratory FailureandRespiratory ArrestBLS

    I.S.MD

    Evaluation of Respiratory PerformanceRespiratory Rate and RegularityLevel of ConsciousnessColor of the Skin and Mucous MembranesRespiratory Mechanics

    I.S.MD

    Respiratory MechanicsHead BobbingNasal FlaringRetractionsGruntingStridorWheezing or Prolonged Exhalation

    I.S.MD

    Upper Airway Obstructionturbulence

    I.S.MD

    Lower Airway Obstruction

    turbulence & wheezing

    I.S.MD

    AnatomyChildren are very different than adults !!!

    I.S.MD

    Anatomy :

    AirwayNose TongueEpiglottis Vocal CordsLarynx

    I.S.MD

    Anatomy: LarynxNarrowest point = cricoid cartilageINFANTADULT

    I.S.MD

    PhysiologyTongue - Posterior DisplacementTongue Difficult to ControlEpiglottis Difficult to ControlVocal Cords Difficult IntubationTube size relative to Cricoid DiameterSmall Airway Edema causes High Resistance

    I.S.MD

    Effect Of EdemaPoiseuilles law

    I.S.MD

    Basic Life Support

    A+B

    I.S.MD

    Two Steps Before1. Ensure the Safety of Rescuer and Victim ( the scene, gloves, barrier devices)

    Partial CPR: Is Something Better than Nothing?

    2. Stimulate and Check Responsiveness

    I.S.MD

    AirwayHead Tilt-Chin LiftJaw Thrust+ Tongue-Jaw Lift Maneuver (FBAO)

    I.S.MD

    Breathing Check Breathing

    LookListenFeelRecovery PositionRescue Breathing

    I.S.MD

    Ventilation withOxygenMouth-to-Mouth ventilation provides only 17% O2Indicated to all seriously ill or injured patients even if pCO2 is highIf Possible humidify OxygenUse of reduced FiO2 is uncommon

    I.S.MD

    Devices to Monitor Respiratory FunctionPulse OxymetryEnd-Tidal CO2Arterial Blood Gas Analysis

    I.S.MD

    Oxygen Delivery SystemsOxygen MaskFace TentOxygen HoodOxygen TentNasal Canula

    I.S.MD

    Oropharyngeal AirwaySIZEPROPER POSITION

    I.S.MD

    Nasopharyngeal Airway

    I.S.MD

    Nasopharyngeal Airway

    I.S.MD

    Bag-Mask VentilationProper area for mask application

    I.S.MD

    Bag-Mask VentilationSellick Maneuver

    I.S.MD

    Laryngeal MaskContraindicated if gag-reflex is intactHigher success rateDoes NOT protect from aspirationDifficult to maintain during transport

    I.S.MD

    Intubation

    I.S.MD

    Intubation: IndicationsFailure to oxygenateFailure to remove CO2Increased WOBNeuromuscular weaknessCNS failureCardiovascular failure

    I.S.MD

    Tracheal Tube Children > 2 years:ETT size: (Age+16)/4ETT depth (lip): ETTsize x 3AgekgETT LengthNewborn3.53.593 mos6.03.5101 yr104.0112 yrs124.512

    I.S.MD

    Better in younger children with a floppy epiglottisStraightLaryngoscope Blades

    I.S.MD

    Laryngoscope BladesBetter in older children who have a stiff epiglottisCurved

    I.S.MD

    Intubation Technique

    I.S.MD

    Confirmation of ETT PlacementNO single technique is 100% reliableClinical ConfirmationChest X-rayCO2 DetectionEsophageal Detector Devices

    I.S.MD

    Clinical ConfirmationChest riseWater vapor seen inside tubeBreath sounds - lungBreath sounds epigastriumO2 Saturation

    I.S.MD

    Acute Deterioration after IntubationD.O.P.E: Displacement Obstruction Pneumothorax Equipment failure

    I.S.MD

    Inadequate Improvement after IntubationInadequate Tidal VolumeExcessive Leak Around The TubeAir Trapping and Impaired Cardiac OutputLeak or Disconnection in Ventilator SystemInadequate PEEPInadequate O2 Flow from Gas Source

    I.S.MD

    Thank You

    I.S.MD

    Percutaneous CricothyrotomyComplete UA Obstruction:FBAOSevere Orofacial InjuriesUpper Airway Infections

    1Adult VF or Pulseless VTIf asystolic, mortality > 90%

    75910