1. AIRWAY
MANAGEMENT
ALS Subcommittee 2010

2. Learning and Skills Objectives
• Describe the “airway hierarchy”
• Be able to use airway devices
• Understand the complications of these airway
devices
ALS Subcommittee 2010

3. “Airway hierarchy”
– Oxygen delivering devices:
• Nasal cannula
• Face mask
– Non-invasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:
• Laryngeal mask airway (LMA)
• Endotracheal tube (ETT)
ALS Subcommittee 2010

4. “Airway hierarchy”
– Oxygen delivering devices:
• Nasal cannula
• Face mask
– Non-invasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:
• Laryngeal mask airway (LMA)
• Endotracheal tube (ETT) ALS Subcommittee 2010

5. Oxygen Delivering Devices
In breathing patients who can protect his airway,
conscious or unconscious
Nasal cannula Simple face mask
Venturi mask Mask with O2 reservoir 2010
ALS Subcommittee

6. “Airway hierarchy”
– Oxygen delivering devices:
• Nasal cannulae
• Face masks
– Non-invasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:
• Laryngeal mask airway (LMA)
• Endotracheal tube (ETT) ALS Subcommittee 2010

7. Oropharyngeal or
Nasopharyngeal Airway
Only in unconscious patient to prevent the
tongue from falling back
Oropharyngeal airway Nasopharyngeal airway
ALS Subcommittee 2010

8. Oropharyngeal and
Nasopharyngeal Airway
in Correct Position
Oropharyngeal airway in Nasopharyngeal airway in
place in the mouth place in the nose
ALS Subcommittee 2010

9. “Airway hierarchy”
– Oxygen delivering devices:
• Nasal cannulae
• Face masks
– Non-invasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:
• Laryngeal mask airway (LMA)
• Endotracheal tube (ETT) ALS Subcommittee 2010

10. Pocket-mask and Bag-mask
To ventilate patients non-invasively
1-way valve
ALS Subcommittee 2010

11. Bag-mask Ventilation
1-hand technique for BVM 2-hand technique for BVM
ALS Subcommittee 2010

12. “Airway hierarchy”
– Oxygen delivering devices:
• Nasal cannula
• Face mask
– Noninvasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:
• Laryngeal mask airway (LMA)
• Endotracheal tube (ETT) ALS Subcommittee 2010

13. Laryngeal Mask Airway (LMA)
The LMA - a SUPRAGLOTTIC airway that
consists of a tube with a cuffed mask-like
projection at distal end
ALS Subcommittee 2010

14. LMA - Indications
• When mask ventilation fails to achieve adequate
oxygenation
• As an adjunct to airway management by
personnel not skilled in tracheal intubation
• As an adjunct to airway management by
personnel skilled in tracheal intubation when
endotracheal intubation is difficult or not
successful ALS Subcommittee 2010

15. Insertion: Preparation
• Choose the appropriate size
• Recommended size guidelines:
– Size 1: < 5 kg
– Size 1.5: 5 - 10 kg
– Size 2: 10 - 20 kg
– Size 2.5: 20 - 30 kg
– Size 3: 30 - 50 kg
– Size 4: 50 – 70 kg
– Size 5: >70 kg
ALS Subcommittee 2010

16. LMA in place in the Mouth
ALS Subcommittee 2010

17. Complications of LMA
 Sore throat
 Dysphagia
 Dryness of the throat and/or mucosa
 Tongue cyanosis
 Vocal cord paralysis
 Major: Aspiration
ALS Subcommittee 2010

18. “Airway hierarchy”
– Oxygen delivering devices:
• Nasal cannula
• Face mask
– Noninvasive airway devices:
• Oropharyngeal airway
• Nasopharyngeal airway
• Pocket-mask device
• Bag-mask device
– Invasive airway devices:
• Laryngeal mask airway (LMA)
• Endotracheal tube (ETT) ALS Subcommittee 2010

19. CONTROL OF THE
AIRWAY WITH
ENDOTRACHEAL TUBE
IS USUALLY REGARDED AS THE
“GOLD STANDARD”
limited to trained and skilled personnel

ALS Subcommittee 2010

20. Endotracheal Intubation
 Weigh benefit of intubation VS adverse effect of
interrupting chest compressions during
intubation
 Intubation should be done by most experienced
person
 Do not take longer than 30 seconds per attempt
ALS Subcommittee 2010

21. Curved Blade Attached to
Laryngoscope Handle
ALS Subcommittee 2010

22. Aligning Axes of Upper Airway
Mouth
A
A B
B
C
C
Pharynx Trachea
Extend-the-head-on-neck (“look up”): aligns axis A relative to B
Flex-the-neck-on-shoulders (“look down”): aligns axis B relative to C
ALS Subcommittee 2010

23. Cricoid Pressure
Thyroid
Cartilage
Cricoid
ALS Subcommittee 2010

24. Visualization of Vocal Cords
Anatomy
Tongue
Vallecula
Epiglottis
Vocal
cord
Glottic Arytenoid
opening cartilage
ALS Subcommittee 2010

25. Endotracheal Intubation
Complications
• Hypoxia – the act of intubation is an hypoxic
event
• Trauma—teeth, lips, tongue, mucosa, vocal
cords, trachea
• Vomiting and aspiration
• Hypertension/hypotension and arrhythmias
ALS Subcommittee 2010

26. Confirmation of advanced
airway placement
• Colour
• Visible chest rise
• Vapour in ETT
• 5 points auscultation
• Capnography / CO2 detector devices
ALS Subcommittee 2010

27. THANK YOU
NATIONAL COMMITTEE ON RESUSCITATION TRAINING
SUBCOMMITEE FOR ADVANCED LIFE SUPPORT
 Dr Tan Cheng Cheng
 Dr Luah Lean Wah
 Dr Ismail Tan bin Mohd Ali Tan
 Dr Wan Nasrudin bin Wan Ismail
 Dr Chong Yoon Sin
 Dr Priya Gill
 Dr Ridzuan bin Dato’ Mohd Isa
 Dr Thohiroh binti Abdul Razak
 Dr Adi bin Osman
ALS Subcommittee 2010