Clinical Science Session

AIRWAY MANAGEMENT
Oleh Ricky Pebriansyah, S. Ked (0818011091)

Pembimbing : dr. Indra Faisal, Sp. An.

KEPANITERAAN KLINIK ANESTESIOLOGI DAN REANIMASI RUMAH SAKIT UMUM DAERAH Dr. Hi. ABDUL MOELOEK FAKULTAS KEDOKTERAN UNIVERSITAS LAMPUNG BANDAR LAMPUNG 20 November 2012

Outline
Masalah airway Tanda dan gejala sumbatan airway akut serta ventilasi tidak adekuat Teknik-teknik pengelolaan airway dan ventilasi Definitive airway Oksigenasi dan ventilasi

I. MASALAH AIRWAY
Trauma maksilofacial Trauma leher Trauma laringeal
a. Suara parau b. Emfisema subkutan c. Teraba fraktur

Penyebab obstruksi jalan nafas : Lidah jatuh, gigi palsu, sekresi benda asing: muntahan, darah, makanan Trauma wajah Radang (epiglotitis dan edema faring) Obstruksi total atau parsial Apnea dan Cardiac arrest dalam 5 10 min.

Obstruksi parsial harus dikoreksi dgn benar jika tidak dapat terjadi kerusakan otak dan kerusakan jantung arrest.

Indications for airway protection

Decreased level of consciousness GCS <9 Cerebral injury Surgery Medical problems

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II. Tanda Sumbatan Airway dan Ventilasi Tidak Adekuat

SUMBATAN AIRWAY 1. Look Agitasi (hipoksia), bodoh (hiperkarbia), sianosis kuku/kulit sekitar mulut, retraksi dan penggunaan otot nafas tambahan. 2. Listen Snoring, gurgling, crowing, dysphonia, kata-kata kasar (gaduh gelisah). 3. Feel Lokasi trakea.

VENTILASI TIDAK ADEKUAT 1. Look Kesimetrisan pergerakan dada. 2. Listen Suara nafas pada kedua dada, takipnea. 3. Pulse oxymeter SaO2 dan perfusi perifer.

III. Teknik Pengelolaan Airway dan Ventilasi

TECHNIQUES TO CLEAR MATERIAL FROM AIRWAY Suction, finger sweep Basic life support chocking protocol
Up to 5 back slaps Up to 5 abdominal thrusts Only if unconscious up to 5 chest thrusts If unsuccessful to clear airway then Basic Life Support

Opening the Airway

Check the airway Open the airway head tilt, chin lift, atau jaw thrust (triple manuver) Remove any visible obstruction from the victims mouth, including dislodged dentures.

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Jaw thrust technique may be needed if C-spine injury

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Simple airway adjuncts

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Nasopharyngeal airway insertion

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Oropharyngeal airway insertion

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Laryngeal Mask Airway (LMA)

IV. DEFINITIVE AIRWAY

Jika tidak sadar Cedera berat maxillofacial Risiko aspirasi, obstruksi, hematom laring/trachea Ventilation-Apnea-respirasi tidak adekuat-cedera kepala berat

1. Pipa orotrakeal 2. Pipa nasotrakeal 3. Airway surgical (krikotiroidotomi atau trakeostomi).

Airway Evaluation
Jaw Movement
Both inter-incisor gap and anterior subluxation <3.5cm inter-incisor gap concerning Inability to sublux lower incisors beyond upper incisors

Receding mandible Protruding Maxillary Incisors (buck teeth)

Obesity
Distribution, i. e. short, thick neck more concerning Neck circumference

Thyromental distance: bony point on mentum (mandible) to thyroid notch If short (<3FBs or 6cm), pharyngeal and laryngeal axis off

Oropharyngeal visualization Mallampati Score Sitting position, protrude tongue, dont say AHH

Difficulty ventilating
Age >55 Beard History of snoring Lack of teeth BMI >26

INTUBASI ENDOTRAKEAL
tindakan memasukan pipa trakhea ke dalam trakhea melalui rima glottis, sehingga ujung pipa berada di pertengahan trakhea antara pita suara dan bifurkasiotrakhea.

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Penentuan Ukuran ETT

Orotrakeal intubation

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Nasotracheal intubation

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Surgical airway
1. Krikotiroidotomi

2. Trakeostomi

Indikasi: tidak dapat intubasi trachea -Edema Glottis -Fractur laring -perdarahan oropharingeal berat

Cricothyroidotomy

Surgical cricothyroidotomy

Trakeostomi

V. OKSIGENASI DAN VENTILASI

Conclusion
Airway management is an extremely important aspect of the practice of anesthesiology and critical care Skills such as mask ventilation, endotracheal intubation, are necessary

DAFTAR PUSTAKA
Augusto Torres, MD, Department of Anesthesiology, MetroHealth Medical Center, 2011. ATLS 2004.