Airways obstruction

1. Neurological
   • Decreased level of consciousness
2. Above larynx
   • Max-Fax trauma
   • Infection - tonsillary hypertrophy
   • Foreign bodies
   • Neoplasms
3. Larynx
   • Laryngeal fracture
   • Infection
   • Laryngeal oedema: smoke inhalation, radiotherapy
4. Below larynx
   • Congenital - subglotting stenosis
   • Neck trauma - haemorrhage
   • Infection - acute laryngotreachobronchitis

Headlift
Chin lift / Jaw thrust (due to attachment of tongue to mandible via genioglossus muscle)
C-spine immobilisation

Oxygen
Venturi mask
Non-rebreathe mask ~85%
Bag-valve mask

Suction
Yankeur sucker
Can promote vomiting/spasm
Suck only what you can see

Simple Airway

1. Oropharyngeal airway
   Sizes 2,3,4
   Sized from incisors to angle of mandible
   Inserted upside down and rotated

2. Nasopharyngeal airway
   Bevelled one end, flanged other end
   Insert with safety pin in end to prevent "loss"
   Sized according to internal diameter: 6-7mm adults (used to be size of little finger)
   Contraindicated in basal skull fracture
3. Laryngeal mask airway
   Sizes 3,4,5
   Insufflated with (size x 10) - 10mls: ie size 4 gets 30mls air
   Tube should lift 1-2cm out of mouth if cuff in correct position
   + insert bite block (ie OPA)
   Risk of leakage of air + aspiration

Definitive airway

"Tube in trachea with an inflated cuff"

Prevents aspiration

Indications; relief of obstruction, protects from aspiration, ventilatory requirement, facilitates suction/toilet 

1. Endotracheal tube
   Needs: x2 laryngoscopes, stethoscope, magils, bougie, tubes, lube, suction
   Detected with CO2 detector or (in arrest) oesophageal suction detector - can detect collapse
   Check (1) epigastrium (2) mid axillary line
   + insert bite block (oropharyngeal airway)

   Pre-oxygenate
   Position head
   Thio / Sux / Tube

2. Cricothyroidotomy
   Needle - between cricothyroid membrane, aim 45' down
   Surgical - extend head, dissect down

   Results in good oxygenation, but poor ventilation - results in hypercarbia (and thus limited to ~45 minutes usage)
   Contraindicated in children (under 12) - risk of damage to cricoid cartilage which is the only support for the paediatric trachea
    

3. Tracheostomy