Tatalaksana Jalan Nafas

Airway
Management
Dr. Andi Ade Wijaya,SpAn
Departemen Anestesiologi
FKUI-RSUPN Cipto Mangunkusumo
Objectives
Anatomy and Physiology of the Airway

Cause of Respiratory Failure
Airway Management
Equipments
Endotracheal Intubations
Pharmacology Drugs Used for Airway
Management
Special Conditions
The Body’s Need for Oxygen
 Living tissue must have oxygen to survive.

 Brain death in humans occurs within 6 to 10
minutes of tissue anoxia.
 Rapid and safe airway control is paramount
to the successful management of critically ill
and injured patients.
Airway Anatomy
Upper airway structures include the:

Mouth Nose
Pharynx Oropharynx
Laryngopharynx Larynx
The lower airway structures include the:
Trachea Bronchi
Bronchioles Alveoli
Lungs
.
The upper airway functions to warm, filter, and
humidify the air before it enters the lower
airway
The functions of the lower airway include air
conduction, filtration, warming, humidification,
and removal of foreign particles.
Respiration occurs in the terminal bronchioles
of the lower airway
Ventilation and Respiration
 Ventilation is the movement of air into and

out of the lungs.
 There are two phases of ventilation:
inspiration and expiration.
 Inspiration is initiated by a stimulus in the respiratory
center of the brain.
 The signal is transmitted to the diaphragm via the
phrenic nerve.
 The impulse causes the diaphragm to contract or
flatten.
 This causes intrapulmonic pressure to fall below
atmospheric pressure and air is drawn into the lungs

like a vacuum.
 The ribs elevate and expand, the alveoli inflate, and
oxygen and carbon dioxide diffuse across the

membrane.
 During expiration,
 the stretch receptors in the lungs signal the
respiratory center of the brain to inhibit the

inspiration impulse.
 The lungs then recoil because of natural
elasticity, and the air is expired.

 The diaphragm returns to its resting
position.
 Respiration is defined as the exchange of gases

between a living organism and its environment.
The major gases of respiration are oxygen (O2)
and carbon dioxide (CO2).
 There are two types of respiration:

 Internal Respiration: The exchange of gases between
the blood cells and tissues.
 External Respiration: The exchange of gases in the
lungs at the alveolar-capillary interface.
 O2 and CO2 are exchanged by diffusion

of the gases across the alveolar
membrane.
 Diffusion is based on the concept that
solutions of a greater concentration will
pass or move into solutions of a lower
concentration.
Mechanisms that lead to Respiratory
Failure
1. Impaired alveolar ventilation
2. Diffusion disturbance
3. Ventilation or perfusion imbalance
4. Right to left shunt
Manual Airway Management Maneuvers–
Head-tilt/Chin lift
Maneuver Head-tilt/Chin lift
Tilt head back

Technique Lift chin forward
Open mouth
Indications Unresponsive patients without c-spine injury, and

those who are unable to protect their own airway
Contraindication Awake and alert patients
s Patients with possible c-spine injury
Advantages No equipment required

Simple
Safe
Non-invasive
Disadvantages Head tilt hazardous to c-spine injured patient

Does not protect from aspiration
Jaw-thrust Without Head-tilt
Maneuver Jaw-thrust without head-tilt
Technique Head is maintained in neutral alignment

Jaw is displaced forward
Lift by grasping under chin and behind teeth
Mouth opened
Indications For patients who are unresponsive, unable to protect their own
airway, or may have a c-spine injury
Contraindications Responsive patients

Patients resistant to opening mouth
Advantages No equipment required
Simple
Safe
Non-invasive
May be used in c-spine injury
May be performed with a c-collar in place
Disadvantages Cannot maintain if patient becomes responsive or

combative
Difficult to maintain for extended period
Very difficult to use in conjunction with bag-valve-mask
ventilation
Thumb must remain in patient’s mouth to maintain
displacement
Does not protect from aspiration
CHIN LIFT
X
HEAD TILT
HEAD TILT never in trauma victims

X CHIN LIFT
X
NECK LIFT X HEAD TILT
JAW THRUST
Airway Devices
Oropharingeal Airway
Manual Ventilation
Ayre’s T-Piece
Laryngoscope
Airway Devices
Oro-pharyngeal tube
Jangan dipakai jika reflex muntah masih (+)

(Derajat A dan V dari AVPU atau GCS > 10)
Naso-pharyngeal tube
Tidak merangsang muntah

Hati-hati pada pasien dengan fraktura basis cranii
Ukuran u/ dewasa 7 mm atau jari kelingking kanan
Airway
Equipment
BASIS CRANII
atap nasopharynx
tulang tipis mudah patah
ARAH TUBE
naso-pharyngeal
Plica vocalis
CRICOTHYROIDOTOMY
Opening Airway (Head Position)
Mask Ventilation
Airway Assessment
Difficult Intubation (Prediction)
Difficult Intubation
(Prediction)
Trachea Intubation
Sellick’s Manuever
 Used to prevent gastric distention

that can accompany intubation
and ventilation
 Technique
 Apply slight pressure
anteriorly over cricoid
cartilage
 Closes off esophagus
Sellick’s
Manuever
Laryngeal Mask Airway (LMA)
  Use in OR
 Gaining use in out-of-
hospital
 Not useful with high
airway pressure
 Not a replacement for
ETT
 Multiple models &
sizes
LMA
Other Airway Devices
Combitube®
100 m l
No. 1
100 ml
No. 1
From AMLS, NAEMT

Surgical Airway
Devices
Cricothyrotomy
Tracheostomy Kit
Fiberoptic
Intubations
Special Conditions
Franceschetti syndrome.
 Mucopolysacharidosis
 Pierre Robins Sequence

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Airway

Anatomy and Physiology of the Airway

 Living tissue must have oxygen to survive.

Upper airway structures include the:

 Ventilation is the movement of air into and

atmospheric pressure and air is drawn into the lungs

oxygen and carbon dioxide diffuse across the

respiratory center of the brain to inhibit the

elasticity, and the air is expired.

 Respiration is defined as the exchange of gases

 There are two types of respiration:

 O2 and CO2 are exchanged by diffusion

Tilt head back

Indications Unresponsive patients without c-spine injury, and

Advantages No equipment required

Disadvantages Head tilt hazardous to c-spine injured patient

Maneuver Jaw-thrust without head-tilt

Technique Head is maintained in neutral alignment

Contraindications Responsive patients

Disadvantages Cannot maintain if patient becomes responsive or

HEAD TILT never in trauma victims

Jangan dipakai jika reflex muntah masih (+)

Tidak merangsang muntah

 Used to prevent gastric distention

From AMLS, NAEMT

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