AIRWAY MANAGEMENT

ELVIE ZULKA KAUTZIA RACHMAWATI

ENT DEPATMENT
CIPTO MANGUNKUSUMO HOSPITAL
FACULTY OF MEDICINE
UNIVERSITY OF INDONESIA
JAKARTA INDONESIA

INITIAL EVALUATION
ASSES URGENCY
Is there acute respiratory
distress?
1. NASAL FLARING
2. TACHYPNEA
3. CYANOSIS
4. RETRACTION
IMMEDIATE ACTION

DROOLING

JAW
THRUST

AVOID THE POSITION

WHICH
CAN COMROMISE THE
AIRWAY

LOCATION
OF
OBSTRUCTION

STRIDOR

OTORHINOLARYNGOLOGY BASIC AND CLINICAL SCIENCE

MECHANICAL OBSTRUCTION OF THE

UPPER AIRWAY

HEMANGIOMA

LARYNGEAL
PAPILLOMA

LARYNGOMALACI

WORK UP OF ACUTE
DISTRES

If there is rapid
progression of the
airway distress then
will have to act soon
Do not agitate the
patient
DO NOT ORDER
LAB if the patients is
in acute
distress
No X Ray
No ABG
No blood work

WORK UP OF ACUTE
DISTRESS
AGITATION
Sign of hypoxia of
airway
Never sedate a
patient in the
setting of airway
distress

LETHARGY in
airway distress :
is late an alarming
sign
Will need to take
immediate action
to maintain the
airway

CRICOTHYROID
MEMBRANE
The cricothyroid
membrane,
1 1-1.5 cm
Lies below the thyroid
cartilage-above the 1st
tracheal ring
Palpating the Adams
apple down, inch, flat
depression between 1st
tracheal ring is felt

CRICOTHYROTOMY

Cricothyrotomy is an emergency procedure

involving incising or puncturing the cricothyroid
membrane to access the trachea for ventilation
purposes

INDICATION
Relief
of life-threatening
upper airway
obstruction in which manual
maneuver
to establish an airway,
endotracheal intubation is not
possible and attempts at

WHAT
TRACHEOTOMY
temporarily create
a surgical opening
in the trachea
TRACHEOSTOMY
the creation of
permanent stoma
between the
trachea and
cervical skin

WHAT
Mechanical obstruction
of the upper airways
Protection of
tracheobronchial tree
from the risk of
aspiration
Respiratory failure
Retention of bronchial
secretions
Elective tracheostomy ,
improve surgical
access, facilitate
ventilation

WHEN

EMERGENCY
TRACHEOTOMY
ELEVTIVE
TRACHEOTOMY

HIGHLIGHT
PRIMERINTUBATION
LOW- HIGH

Tracheosto
my or
Cricotyroto
my??

PREPARE THE
NECK

THYROID ISTHMUS

HORISONTAL
INCISSION

SEPARATE THE

STRAP MUSCLES

IDENTIFY THE

TRACHEAL INCISION

TUBE

DONE

COMPLICATION

 HE WHO FAIL TO PREPARE, PREPARE

TO FAIL

THANK
YOU