Airway Management - DR Dedi SpAn

 

Airway Manageme Management nt dedi atila

 

RJP 

Basic Life Support

Advance Life Support  Prolonged Life Support 

 

Basic Life Support 

Airway: Melindungi dan menjaga jalan nafas pasien termasuk penggunaan alat bantu

jalan nafas seperti alat bantu oral atau nasal. 

Breathing:

Pemberian bantuan aliran udara respirasi (ventilasi) termasuk pemberian oksigen. 

Circulation: Bantuan pemompaan jantung dengan pijat jantung tertutup atau terbuka

 

Airway Management 

Teta etap p ter terjag jagany anya a sal salur uran an yan yang g men menghu ghubun bungk gkan an

par aru u de deng ngan an uda darra lua uarr.  Par aru u am aman an dar arii ke kem mun ungk gkin inan an te terj rjad adin inya ya aspirasi.

 

Anatomi Inferior turbinate Major nasal airway

Vallecula

Epiglottis

Hyoid bone Hyoepiglottic ligament Thyroid (laryngeal) cartilage Cricoid cartilage

 

Anatomi Hyoid bone

Laryngeal prominence (“Adam’s appple”) Thyroid (laryngeal) cartilage Cricothyroid membrane Cricothyroid cartilage

Thyroid gland

 

Airway assesment 

Metode “LEMON” Menilai kemungkinan kesulitan tatalaksana jalan nafas



L : Look externally (trauma wajah, gigi seri besar, besar, janggut atau kumis, dan lidah besar)



E : Evaluate the 3-3-2 rule (3 jari pasien membuka mulut, jarak hyoid/mental < 3 ujung jari, jarak tiroid-mulut < 2 ujung jari)



M : Mallampati score

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O : Obstruction (adanya kondisi apapun yg bisa menyebabkan hambatan jalan nafas)



N : Neck Mobility (mobilitas leher terbatas)

 

Skor Mallampati

     

Do with patient sitting, the head head in the neutral neutral position, position, The mouth wide open, The tongue protruding to the maximum. maximum. The patient patient should should not be phonating phonating.. The Mallamp Mallampati ati classificatio classification n is then assigned assigned based based upon the the visible pharyngeal structures.

 

Skor Mallampati



Class I: visualisasi visualisasi pallatum molle, fauce, uvula, pilar anterior dan posterior.  Class II: visualisasi visualisasi pallatum molle, molle, fauce, dan uvula. uvula.  Class III: visualisasi visualisasi pallatum molle, molle, fauce, dan dasar dasar uvula.  Class IV: pallatum molle tidak tampak.

 

Obstruction



Blood in the upper airway

 

Foreign body Expanding hematoma



Abscess

 

Swelling of intraoral structures Laryngeal edema

 

Flexion and extension of neck

 

Airway management Head Tilt / Eks Eksten tensi si Kep Kepala ala Pas asie ien n tl tlen enta tang ng & peno penolo long ng di sam sampi ping ng pa pasi sien en,, leta letakk kkn n di bw bwh leher & tlapak tgn yg lain di da dahi. Eksste Ek tens nsik ikan an ke kepa pala la dg dgn n mn mndo doro rong ng da dahi hi ke be bela laka kang ng mengangkat meng angkat leher leher.. Indi In dik kas asii : Obs Obstr truk ukssi ja jari ring ngan an lu luna nak k ja jala lan n na nafa fass at atas as KI : Fra Frakt ktur ur ba bagi gian an le lehe herr Infant Kom ompl plik ikas asii : Ny Nyer erii le lehe herr Syara Sya raff te terj rjep epit it

 

Airway management Chin Lift / Angk Angkat at Da Dagu gu Pas asie ien n te terl rlen enta tang ng & pe peno nolo long ng me mele leta takk kkan an sa satu tu ta tang ngan an di dahi dan ibu ajri tangan yg lain di di bw bwh dagu. Dahi Da hi di dido doro rong ng & da dagu gu di dian angk gkat at sc scrr be bers rsam amaa aan. n. Indi In dika kasi si : Alte Altern rnat atif if he head ad tilt tilt KI : sama sama dg head head tilt Kom ompl plik ikas asii : sama sama dg hea head d tilt tilt

 

Airway management  Jaw Thrust / Dorong Rahang Dr atas kepala pasien, ibu jari diletakkan di maksila & jari lain di angulus mandibula (bilateral), angkat & dorong rahang ke depan. Indikasi : pasien KI atau tdk efektif dg head tilt KI : fraktur rahang dislokasi rahang pasien sadar Komplikasi : dislokasi rahang

 

Airway management Buka Bu ka mu mulu lutt Mulutt di bu Mulu buka ka dg dgn n me meng ngg gun unak akan an ib ibu u ja jari ri Indi In dika kasi si : obstr obstruk uksi si ek eksp spir irat ator orii se sete tela lah h head tilt. tilt. KI : Kom ompl plik ikas asii : Head tilt, jaw thrust & open mouth di dike kena nall se seba baga gaii Tri ripl ple e Airway Manuver

 

Lateral xanogram of the head & neck neck in neutral neutral position. Patient Patient is awake & supine.

 

Medial sagittal view of upper airway showing site of upper

airway obstruction in sedated patient.

 

Airway Management Heimlich Manuver Pad ada a pa pasi sien en berd be rdir iri, i, ka kait itka kan n ke kedu dua a ta tang ngan an mel eliingk gkar arii da dada da pasi pasien en dg dgn n ta tan nga gan n kan anan an men enge gepa pall & tang tangan an ki kiri ri di dik kai aitk tkan an di ata atass kepa ke pala lan n ta tang ngan an ka kana nan. n. Dgn Dg n do doro ron nga gan n ce cepa patt & kua uat, t, men ene ekan ke at atas as,, meni me ning ngka katk tkan an te teka kana nan n su subdi bdiag agfr frag agma ma & meni me nimb mbul ulka kan n ba batu tuk k ar arti tifi fisi sial al.. Indi In dika kasi si : Ob Obst stru ruks ksii to tota tall ol oleh eh be bend nda a as asin ing g KI : Fr Frak aktu turr ig iga a (r (rel elat atif if)) Kon ontu tusi sio o ja jant ntun ung g (r (rel elat atif if)) Obst Ob stru ruk ksi ja jallan naf afas as pa pars rsiial Komplik Ko mplikasi: asi: fraktu frakturr iga, sternu sternum m trau tr auma ma ha hati ti at atau au li limp mpa a

 

Airway Management Heimlich Manuver Pad ada a pa pasi sien en be berd rdir iri, i, kait kaitka kan n ke kedu dua a ta tang ngan an me meli ling ngka kari ri da dada da pasi pasien en dg dgn n ta tang ngan an ka kana nan n me meng ngep epal al & tang tangan an ki kiri ri di dika kait itka kan n di ata atass ke kepa pala lan n tangan tan gan kanan. kan an. Dgn dor dorong ongan an cep cepat at & kua kuat, t, men meneka ekan n ke at atas, as, me menin ningka gkatka tkan n te tekan kanan an subdia sub diagfr gfrag agma ma & me menim nimbu bulka lkan n bat batuk uk art artifi ifisia sial. l. Indi In dika kasi si : Obstr Obstruk uksi si to tota tall oleh oleh be bend nda a as asin ing g KI : F Frak raktu turr iga (re (relat latif) if) Kont ontusi usio o jan jantun tung g (re (relat latif) if) Obst Ob stru ruks ksii ja jala lan n na nafa fass pa pars rsia iall Komplikasi: Kompl ikasi: fraktur iga, sternum trau tr auma ma hati hati at atau au li limp mpa a

 

Airway Management  

 

Jika anda sendiri dan anda tersedak, anda dapat melakukan manuver Heimlich sendiri. Sandarkan ke depan dan tekan abdomen anda secara cepat pada benda sekitar, seperti kursi, meja atau rel pada dinding. Tanpa oksigen, otak akan mulai mengalami kematian dalam waktu 4-6 menit. The Heimlich Maneuver merupakan metode terbaik untuk mengeluarkan benda asing dari jalan nafas pada pasien yang tersedak

 

Airway Management Oropha Oro pharyn ryngea geall Air Airway  way  Men Me nce cega gah h ok oklu lusi si gi gig gi, lb lbh h se serrin ing g ut utk k me mem mpe perrba baik ikii ja jala lan n nafas. Ukuran Ukur an va varria iassi 00-4 4 Ter erbu buat at dr pl plas asti tik, k, met metal al,, atau atau ka kare ret. t. Dira Di ranc ncag ag pd ba bag g gi gigi gita tan n ke kera ras, s, da dan n te tepi pi pr prok oksi sima mall bers be rsir irip ip ut utk k me menc nceg egah ah ov over erin inse sers rsi. i. Bagi Ba gian an di dist stal al be berb rben entu tuk k se semi misi sirk rkul uler er se sesu suai ai be bent ntuk uk lengkung lengk ung mulut, lidan, dan farin faring g poster posterior ior..

 

Airway Management Nasopharyngeal airway  Merupa Meru paka kan n si sili lind nder er pa panj njan ang g yg be berb rben entu tuk k le leng ngku kung ngan an dan len lentur tur.. Terb rbua uatt dr pl plas asttik at atau au ka kare rett le lem mbu but. t. Pan anja jang ng & lebar lebar be berv rvar aria iasi si.. Siri Si rip p pr prok oksi sima mall me menc nceg egah ah ov over erin inse sers rsii

 

Airway Management

 Sung ngk kup  Intubasi

Lari ring ng (L (LM MA) Endotrakeal

 Trakeostomi  Krikotiromi

 

Laryngeal Mask Airways (LMA)

 

•

The LMA was invented by Dr. Archie Brain at the

•

London Hospital, Whitechapel in 1981 The LMA consists of two parts:

•

 –

The mask 

 –

The tube

The LMA has proven to be very effective in the management of airway crisis

 

•

The LMA design:  –

Provides an “oval seal around the laryngeal inlet” once the LMA is inserted and the cuff inflated.

 –

Once inserted, it lies at the crossroads of the digestive and respirat respiratory ory tracts. tracts.

 

Indicatio ns for for the the use of the the LMA LMA Indications

•

Situations involving a difficult mask (BVM) fit.

•

May be used as a back-up device where endotracheal intubation is not successful.

•

May be used as a “second -last-ditch” airway where a surgical airway is the only remaining option.

 

Equipm ent for for LMA Inse Inserti rtion on Equipment 

Body Substance Isolation equipment

 

Appropriate size LMA Syringe with appropriate volume for LMA cuff inflation



Water soluble lubricant



Ventilation equipment



Stethoscope



Tape or other device(s) to secure LMA

 

Prepar reparation ation of the the LMA for Insertion Insertion



Step 1: Size selection

 

Step 2: Exami Examinatio nation n of the LMA Step 3: Check deflation and inflation of the cuff 



Step 4: Lubri Lubrication cation of the the LMA

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Step 5: Positi osition on the Airway Airway

 

Step 1: Size Selection



Verify that the size of the LMA is correct for the patient



Recommended Size guidelines:



Size 1:

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Size 1.5: 5 to 10 kg

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Size 2:

 

Size 2.5: 20 to 30 kg Size 3: 30 kg to small adult

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Size 4:

adult

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Size 5:

Large adult/poor seal with size 4

under 5 kg

10 to 20 kg

 

Step Examinat nation ion of the the LMA LMA Step 2: Exami



Visually inspect the LMA cuff for tears or other



abnormalities Inspect the tube to ensure that it is free of blockage or loose particles



Deflate the cuff to ensure that it will maintain a vacuum



Inflate the cuff to ensure that it does not leak

 

Step 3: Deflation and Inflation of the LMA 

Slowly deflate the cuff to form a smooth flat wedge shape which will pass easily around the back of the tongue and behind the epiglottis.



During inflation the maximum air in cuff should not exceed:



Size 1:



Size 1.5: 7 ml

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Size 2:

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Size 2.5: 14 ml

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Size 3:

20 ml

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Size 4:

30 ml

Size 5:

40 ml

4 ml

10 ml



 

Step Lubricat cation ion of the the LMA LMA Step 4: Lubri



Use a water soluble lubricant to lubricate the LMA



Only lubricate the LMA just prior to insertion Lubricate the back of the mask thoroughly



Important Notice: Notice: 



Avoid Avo id excessive amounts of lubricant 

on the anterior surface of the cuff or



in the bowl of the mask.

Inhalation of the lubricant following placement may result in coughing or obstruction

 

Step 5: Positio Positioning ning of the Airw Airway ay



Extend the head and flex the neck



Avoid LMA fold over: 

Assistant pulls the lower jaw downwards.



Visualize the posterior oral airway.



Ensure that the LMA is not folding over in the oral cavity as it is inserted.

 

Insertion LMA Technique

 

LMA Insertio Insertion n



Grasp the LMA by the tube, like a pen asholding near asitpossible to the mask end.



Place the tip of the LMA against the inner surface of the patient’s upper teeth

Step 1

 

LMA Insertio Insertion n 

Under direct vision: 

Press the mask tip upwards against the hard palate to flatten it out.



Using the index finger, finger, keep pressing upwards as you advance the mask into the pharynx to ensure the tip remains flattened and avoids the tongue.

Step 2

 

LMA Insertio Insertion n



Keep the neck flexed and head extended:  Press

the mask

into the posterior pharyngeal wall using the index finger.

Step 3

 

LMA Insertio Insertion n



Continue pushing with your index finger.  Guide

the mask

downward position. into

Step 4

 

LMA Insertio Insertion n



Grasp the tube firmly with the other hand 

then withdraw your index finger from the pharynx.



Press gently downward with your other hand to ensure the mask is fully inserted.

Step 5

 

LMA Insertio Insertion n



Inflate the mask with the recommended volume vo lume of air air..



Do not over-inflate the LMA.



Do not touch the LMA tube while it is being inflated unless the position is obviously unstable. 

Normally the mask should be allowed to rise up slightly out of the hypopharynx hypopharynx as it is inflated inflated to find its correct

Step 6

 

Verify Placement of the LMA



Connect the LMA to a Bag-Valve Mask device or

low pressure ventilator  Ventilate the patient while confirming equal breath sounds over both lungs in all fields and the absence of ventila absence ventilatory tory sounds over over the epigastrium

 

Securing the LMA



Insert a bite-block or roll of gauze to prevent occlusion of the tube should the patient bite down.



Now the LMA can be secured utilizing the same techniques as those employed in the securing of an endotracheal tube.

 

Problems with LMA Insertion



Failure to press the deflated mask up against the hard palate or inadequate lubrication or cause deflation can the mask tip to fold back on itself.

 

Problems with LMA Insertion



Once the mask tip has started to fold over,, this over t his may m ay progress, pushing the epiglottis into its down-folded position causing mechanical obstruction

 



If the mask tip is deflated forward it can push down the epiglottis causing obstruction



If the mask is inadequate inadequately ly deflated it may either 

push down the epiglottis



penetrate the glottis.

 

Intubasi Endotrak Endotrakeal eal

 

Indi kas asii in intu tubas basii en endo dotr trak akeal eal Indik 

Forr supporting ventilation in patient with some pathologic disease Fo Upper airway obstruction Respiratory Respi ratory failure Loss of conciousness



For supporting ventilation during general anesthesia Type of surgery Operative site near the airway Abdominal or thoracic surgery Prone or lateral position Long period of surgery

 

Patient has risk of pulmonary aspiration Difficult mask ventilation

 

Persiapan



Scop : Laringoskop dan stetoskop

 

Pipa a (tu (tub be) end endot otra rake keal al Tube : Pip Orapharyngea yngeall airway airway Airway : Oraphar



Tape

 

ntroducer ucer : Alat bantu pengarah pengarah Introd menghubungkan antar antar lumen (pipa) Connector : Alat yg menghubungkan



ucti tion on Suc

: Tape utk fiksasi

: Al Alat at pe peng nghi hisa sap p cair cairan an da dan n per perle leng ngka kapa pann nnya ya

 

Laryngoscope : handle and blade

 

LARYNGOSCOPIC BLADE  

Macintosh (curved) and Miller (straight) blade Adult : Macintosh blade, small children : Miller blade

Miller b bllade

Macintosh blade

 

Endotrach Endotracheal eal tube

 

Endotracheal tube Size of endotracheal tube : internal diameter (ID) Male: ID 8.0 mms . Fem Female ale : ID 7.5 mms 

New born - 3 month monthss : ID 3.0 mms



3-9 months

: ID 3.5 mms



9-18 months

: ID 4.0 mms



2- 6 yrs

: ID = (A (Age/ ge/3) 3) + 3.5



> 6 yrs

: ID = (Age/4) + 4.5

 

Material : Red rubber or PVC Endotracheal tube cuff 

High volume Low volume Low pressure cuff High pressure cuff 

 

Oropharyngeal or nasopharyngeal airway

Oral airway Nasal airway

 

Sniffing position Sniffing

 

Preoksigenasi



Selama tahap persiapan, pasien harus diberikan100 diberikan100% % O2.



Menggunakan resuscitator manual (O2 15 L/menit, dengan sistem Menggunakan reservoir O2 yang berfungsi) dengan sungkup muka yang pas.



Jika ventilasi spontan pasien dirasakan tidak memadai, diperlukan ventilasi assisted inspirasi.



Pada pasien apnea, ventilasi tekanan positif akan dibutuhkan. Preoksigenasi adalah langkah yang sangat penting. Jika langkah ini tidak dilakukan, pasien berisiko mengalami hipoksemia berat selama dilakukan intubasi.



 

KONFIRMASI LOKASI ETT



Objektif   



Melihat langsung ETT melewati pita suara EtCO2

Subjektif  

Melihat kembangan dada

 

Auskultasi dada Auskultasi lambung



Saturasi O2



Adanya uap di ETT

 

Complication of endotracheal intubation During intubation ©

Trauma to lip, tongue or teeth

©

Hypertension and tachycardia or arrhythmia

©

Pulmonary aspiration

©

Laryngospasm

©

Bronchospasm

© ©

Laryngeal edema Arytenoid dislocation -> hoarseness

©

Increased intracranial pressure

©

Spinal cord trauma in cervical spine injury inj ury

©

Esophageal intubation

 

Complication of endotracheal intubation During remained intubation ®

Obstruction Obstruct ion from klinking , secretion secretion or overinflat overinflation ion of cuff cuff

®

Accidental Accide ntal extuba extubation tion or endobr endobronchial onchial intubat intubation ion

®

Disconnection from breathing circuit

®

Pulmonary aspiration

®

Lib or nasal ulcer in case with prolong period of intubation

®

Sinusitis or otitis in case with prolong nasoendotracheal intubation

 

Complication of endotracheal intubation During extubation 

Laryngospasm Pulmonary aspiration



Edema of upper airway



 

Complication of endotracheal intubation After extubation 

Sore throat Hoarseness



Tracheal stenosis (Prolong intubation)



Laryngeal granuloma



 

Trakeostomi

 

Trakeostomi

MAKING AN OPENING OPEN ING IN THE ANTERIOR WALL OF TRACHEA & CONVERTING IT IN TO TO A ST STOMA OMA ON THE SKIN THE SURF SURFACE ACE

 

Indications o f Tracheosto Tracheostomy my Indications of There are three main indications 

A. Respiratory obstruction.



B. Retained secretions.



C. Respiratory insufficiency.

 

Respiratory obstruction Infections 

Acute laryngo-tracheo-bronchitis, acute epiglottitis, diphtheria Ludwig's angina, peritonsillar, retropharyngeal or parapharyngeal abscess, tongue abscess

Trauma 

External injury of larynx and trachea ,Trauma ,Trauma due to endoscopies, especially in infants and children,Fracture children,Fracturess of mandible or maxillofacial injuries

Neoplasms 

Benign and malignant neoplasms of larynx, pharynx, upper trachea, tongue and thyroid

Foreign body larynx Oedema larynx 

due to steam, irritant fumes or gases, allergy (angioneurotic or drug sensitivity), radiation

Bilateral abductor paralysis Congenital anomalies



Laryngeal web, cysts, tracheo-oesophag tracheo-oesophageal eal fistula Bilateral choanal atresia

 

Retained secretions 1. Inability to cough 

Coma of any cause, e.g. head injuries, cerebrovascular cerebrovascular accidents, narcotic overdose



Paralysis of respiratory muscles, e.g. spinal injuries, polio, Guillain-Barre syndrome, myasthenia gravis



Spasm of respiratory muscles, tetanus, eclampsia, strychnine poisoning

2. Painful cough 

Chest injuries injuries,, multiple multiple rib fractu fractures, res, pneumo pneumonia nia

3. Aspiration of pharyngeal secretions 

Bulbar polio, polyneuritis, bilateral laryngeal paralysis

 

Respiratory insufficiency



Chronic lung conditions, viz. emphysema, chronic bronchiti bron chitis, s, bronc bronchiect hiectasis, asis, atelectasis atelectasis

 

Types of Tracheostomy



Emergency tracheostomy



Elective or tranquil tracheostomy



Permanent tracheostomy



Percutaneous Pe rcutaneous dilatational tracheostomy



Mini tracheostomy (cricothyroidotomy)

 

Technic



Whenever possible, endotracheal endotracheal intubation should be done before



tracheostomy. This is specially important in infants and children. Position 



supine with a pillow under the shoulders so that neck is extended.

 Anaesthesia 

No anaesthesia anaesthesia }unconsci }unconscious ous patients/ emergency emergency procedure.



conscious patients, 1-2% lignocaine with epinephrine



GA with intubation+/-

 

1. A vertical incision 

in the midline of neck, extending exten ding from cricoid cartilage to just above the sterna ste rnall not notch. ch.



This is the most favoured incision and incision and can be used in in emergency and elective procedures.



It gives rapid access with

minimum of bleeding and tissue tissue dissection.

 

transverse incision, 5 cm A transverse long, made 2 fingers' breadth bread th above the stern sternal al notch can be used in elective procedures. It has the adv advant antage age of a cosmetically better scar .

 



2. After incision, tissues are dissected in the midline.



Dilated veins are either displaced Dilated displaced or ligated. ligated. 3. Strap muscles are separated in the midline and retracted laterally l aterally..



4. Thyroid isthmus is, displaced between betw een the clamps, clamps and suture-liga sutureupwards -ligated. ted.or divided

 



6. Trachea Trachea is fixed with a hook and opened with a vertical incision in the

region of 3rd and 4th or 3rd and 2nd rings. This is then converted into a circular opening. The first tracheal ring is never divided as  perichondritis  perichond ritis of cricoid cartilage with with stenosis stenosis can result result (Fig. 63.2). 

7. Tracheostomy Tracheostomy tube of appropriate size s ize is inserted and secured by tapes



8. Skin incision should not be sutured or packed tightly as it may lead to development of subcutaneous emphysema.



9. Gauze dressing is placed between the skin and flange of the tube around the stoma.

 

Complications 

 A. Immediate (at the time of operation):

1. Haemorrhage. 2. Apnoea. This follows opening of trachea in a patient who had prolonged respiratory obstruction. This is due to sudden washing out of CO2 which was acting as a respiratory stimulus. Treatment Treatment is to administer 5% CO in oxygen or assisted ventilation. 3. Pneumothorax due to injury to apical pleura. 4. Injury to recurrent laryngeal nerves. 5. Aspiration of blood.

6. Injury to oesophagus. This can occur with tip of knife while incising the trachea and may result result in tracheotracheo-oesoph oesophageal ageal fist fistula. ula.

 

Complications



B. Intermediate (during first few hours or days):

1. Bleeding, reactionary or secondary. 2. Displacement of tube. 3. Blocking of tube. 4. Subcutaneous emphysema.

5. Trac Tracheitis heitis and tracheobronch tracheobronchitis itis with crusting crusting in trachea. trachea. 6. Atelectasis Atelectasis and lung abscess. 7. Local wound infection and granulations.

 

Complications 

C. Late (with prolonged use of tube for weeks and months):

1. Haemorrhage, due to erosion of major vessel. 2. Laryngeal stenosis, due to perichondritis of cricoid cartilage. 3. Tracheal Tracheal stenosis, due to tracheal ulceration and infection. 4. Tracheo-oesophageal Tracheo-oesophageal fistula, due to prolonged use of cuffed tube tube or erosion of trachea by the tip of tracheostomy tube. 5. Problems of decannulation. Seen commonly in infants and children. 6. Persistent tracheocutaneous fistula. 7. Problems of tracheostomy scar. Keloid or unsightly scar.

8. Corrosion of tracheostomy tube and aspiration aspiration of its fragments into the tracheobronchial tree.

 

Krikotirotomi

 

Krikotirotomi



Merupakan prosedur darurat yang penting yang digunakan untuk mendapatkan jalan nafas saat metode lain yang lebih rutin (misalnya, mendapatkan jalan nafas topeng laryngeal [LMA] dan intubasi endotrakeal) tidak efektif atau dikontraind dikontraindikasikan. ikasikan.

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Menetapkan jalan napas yang efektif dalam menghadapi keadaan darurat medis merupakan keterampilan yang harus dimiliki petugas kesehatan untuk mencegah morbiditas atau mortalitas pasien.

 

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Kegagalan untuk mendapatkan jalan nafas dengan metode tradisional dalam situasi berikut : 

Trauma yang menyebabkan pendarahan oral, faring, atau nasal

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Spasme otot-otot wajah atau laringospasme

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Muntah yang tidak terkendali

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Stenosis atau kelainan bawaan saluran napas bagian atas

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Gigi yang terkatup

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Tumor, kanker, kanker, atau proses penyakit lain atau trauma yang menimbulkan efek massa

Obstruksi jalan nafas meliputi: 

Edema Orofaringeal (misalnya anafilaksis)

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Obstruksi karena benda asing

Indikasi relatif  

Imobilisasi tulang belakang servikal sekunder akibat cedera

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Cedera maksilofasial

Indikasi non-emergensi 

Intubasi lama (prolonged)

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Operasi di daerah maksillofacial, laring atau oral

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Bronkoskopi

 

Kontraindikasi

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Kontraindikasi Kont raindikasi absolut, umur (batasan masih kontroversial ; dibawah 5-12

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tahun Anak-anak di bawah 12 tahun memiliki selaput kriotiroid yang lebih kecil dan laring yang lebih berbentuk corong

 

Perti ertimban mbangan gan Tekni ekniss 

Trakeostomi permanen harus ditempatkan dalam waktu 24 jam.

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Jarum krikotirotomi dapat digunakan selama kurang lebih 40 menit, setelah waktu dimana karbon dioksida terakumulasi; hal ini bisa sangat berbahaya pada pasien trauma kepala.

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Stoma dgn krikotiroidotomi yang dipertahankan dipertahankan selama lebih dari 2 hari berkaitan dengan risiko stenosis glotis dan subglotis yang lebih tinggi daripada trakeostomi.

 

Tekni eknik k Pemasanga Pemasangan n 

Krikotirotomi dgn jarum (needle krikotirotomi)

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Krikotirotomi perkutan (teknik Seldinger)

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Krikotiromi pembedahan

 

Krikotiromi Jarum 

Posisikan pasien, oleskan lidokain (jika diindikasikan), Posisikan dan siapkan bidang steril, termasuk pembersihan dengan larutan antiseptik.

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Identifikasi landmark anatomi.

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Siapkan jarum suntik yang diisi larutan NaCl

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Tusukkan jarum, seiring jarumnya maju, lakukan

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aspirasi Saat melintasi membran dan memasuki trakea, akan terasa spt memasuki rongga, dan ada gelembung udara

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Sambungkan dgn kateter

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Berikan ventilasi jet

 

Krikotirotomi Perkutan 

Melanjutkan tahapan krikotirotomi jarum

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Masukkan kawat penuntun mll lubang jarum.

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Cabut jarum, pertahankan kawat penuntun

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Insisi kecil pada stoma Lebarkan dgn dilatator

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Pasang pipa krikotiromi

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Cabut kawat penuntun

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Fiksasi

 

Krikotirotomi Pembedahan 

Setelah menentukan landmark

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Dengan tangan dominan, buat sayatan vertikal garis tengah, kira-kira panjangnya 3 cm dan kulit dalam, di atas membran krikotiroid.

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Palpasi membran krikotiroid melalui sayatan, dengan menggunakan telunjuk tangan nondominan.

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Buat sayatan tusukan horizontal melalui selaput.

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Sebuah pop yang berbeda akan terasa saat pisau bedah menembus membran dan memasuki trakea.

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Dilatasi sayatan secara vertikal, gunakan dilator Trousseau dengan tangan nondominan.

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Dengan tangan yang dominan, masukkan tabung trakeostomi di antara 2 bilah bila h dilator, dilator, arahkan awalnya ke satu sisi pasien. Setelah tabung ta bung melewati membran, putar 90 o dan sisipkan secara kaudal.

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Lepaskan obturator, obturator, dan masukkan kanula bagian dalam. Kunci ke tempatnya.

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Kembangkan balon dengan 5-10 mL udara. Pasang tabung ke BVM dan berikan b erikan ventilasi.

 

Komplikasi Dini

Lama

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Perdarahan

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Disfonia

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Malposisi

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Infeksi

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Emfisema subkutis

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Obstruksi

Hematoma

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Perforasi esofagus/mediastinum

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Stoma persisten

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Aspirasi

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Jaringan parut

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Cedera pita suara

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Stenosis glotis atau sub glotis

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Pneumtorak

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Stenosis laring

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Cedera laring

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Fistula trakeoesofageal

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Trakeomalasia

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Perforasi dinding posterior trakea Perforasi tiroid

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Hiperkarbia (krikotiromi jarum)