Clinical Science SessionClinical Science Session

AIRWAY MANAGEMENTAIRWAY MANAGEMENT

OlehOleh

Ricky Pebriansyah, S. Ked Ricky Pebriansyah, S. Ked (0818011091)(0818011091)

Pembimbing : Pembimbing : dr.dr. Indra Faisal, Indra Faisal, Sp. Sp. An.An.

KEPANITERAAN KLINIK KEPANITERAAN KLINIK ANESTESIOLOGI ANESTESIOLOGI DAN DAN REANIMASIREANIMASIRUMAH SAKIT UMUM DAERAH Dr. Hi. ABDUL MOELOEKRUMAH SAKIT UMUM DAERAH Dr. Hi. ABDUL MOELOEK

FAKULTAS KEDOKTERAN UNIVERSITAS LAMPUNGFAKULTAS KEDOKTERAN UNIVERSITAS LAMPUNGBANDAR LAMPUNGBANDAR LAMPUNG20 November 201220 November 2012

OutlineOutline

Masalah airwayMasalah airway

Tanda dan gejala sumbatan airway akut Tanda dan gejala sumbatan airway akut serta ventilasi tidak adekuatserta ventilasi tidak adekuat

Teknik-teknik pengelolaan airway dan Teknik-teknik pengelolaan airway dan ventilasiventilasi

Definitive airwayDefinitive airway

Oksigenasi dan ventilasiOksigenasi dan ventilasi

I. MASALAH AIRWAYI. MASALAH AIRWAY

Trauma maksilofacialTrauma maksilofacial

Trauma leherTrauma leher

Trauma laringealTrauma laringeala. Suara paraua. Suara paraub. Emfisema subkutanb. Emfisema subkutanc. Teraba frakturc. Teraba fraktur

Penyebab obstruksi jalan nafas :Lidah jatuh, gigi palsu, sekresi benda asing: muntahan, darah, makananTrauma wajahRadang (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.

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Indications for airway protectionIndications for airway protection

Decreased level of consciousness Decreased level of consciousness

GCS <9GCS <9

Cerebral injury Cerebral injury

SurgerySurgery

Medical problemsMedical problems

II. Tanda Sumbatan Airway dan II. Tanda Sumbatan Airway dan Ventilasi Tidak AdekuatVentilasi Tidak Adekuat

SUMBATAN AIRWAYSUMBATAN AIRWAY

1.1. Look Look Agitasi (hipoksia), bodoh Agitasi (hipoksia), bodoh (hiperkarbia), sianosis kuku/kulit sekitar (hiperkarbia), sianosis kuku/kulit sekitar mulut, retraksi dan penggunaan otot nafas mulut, retraksi dan penggunaan otot nafas tambahan.tambahan.

2.2. Listen Listen Snoring, gurgling, crowing, Snoring, gurgling, crowing, dysphonia, kata-kata kasar (gaduh gelisah).dysphonia, kata-kata kasar (gaduh gelisah).

3.3. Feel Feel Lokasi trakea. Lokasi trakea.

VENTILASI TIDAK ADEKUATVENTILASI TIDAK ADEKUAT

1.1. Look Look Kesimetrisan pergerakan dada. Kesimetrisan pergerakan dada.

2.2. Listen Listen Suara nafas pada kedua dada, Suara nafas pada kedua dada, takipnea.takipnea.

3.3. Pulse oxymeter Pulse oxymeter SaO SaO22 dan perfusi dan perfusi

perifer.perifer.

III. Teknik Pengelolaan Airway III. Teknik Pengelolaan Airway dan Ventilasidan Ventilasi

TECHNIQUES TO CLEAR MATERIAL FROM TECHNIQUES TO CLEAR MATERIAL FROM AIRWAYAIRWAYSuctionSuction, finger sweep, finger sweepBasic life support chocking protocolBasic life support chocking protocol– Up to 5 back slapsUp to 5 back slaps– Up to 5 abdominal thrustsUp to 5 abdominal thrusts– Only if unconscious up to 5 chest thrustsOnly if unconscious up to 5 chest thrusts– If unsuccessful to clear airway then Basic Life If unsuccessful to clear airway then Basic Life

SupportSupport

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Opening the AirwayOpening the Airway

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

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Jaw thrust technique may be Jaw thrust technique may be needed if C-spine injuryneeded if C-spine injury

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Simple airway adjunctsSimple airway adjuncts

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Nasopharyngeal airway Nasopharyngeal airway insertioninsertion

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Oropharyngeal airway insertionOropharyngeal airway insertion

Laryngeal Mask Airway (LMA)Laryngeal Mask Airway (LMA)

Jika tidak sadarJika tidak sadar

Cedera berat maxillofacialCedera berat maxillofacial

Risiko aspirasi, obstruksi, hematom Risiko aspirasi, obstruksi, hematom laring/trachealaring/trachea

Ventilation-Apnea-Ventilation-Apnea-respirasi tidak respirasi tidak adekuatadekuat--cedera kepala beratcedera kepala berat

IV. DEFINITIVE AIRWAYIV. DEFINITIVE AIRWAY

1. Pipa orotrakeal1. Pipa orotrakeal

2. Pipa nasotrakeal2. Pipa nasotrakeal

3. Airway surgical (krikotiroidotomi atau 3. Airway surgical (krikotiroidotomi atau trakeostomi).trakeostomi).

Airway EvaluationAirway Evaluation

Jaw MovementJaw Movement– Both inter-incisor gap and Both inter-incisor gap and

anterior subluxationanterior subluxation– <3.5cm inter-incisor gap <3.5cm inter-incisor gap

concerningconcerning– Inability to sublux lower Inability to sublux lower

incisors beyond upper incisors beyond upper incisorsincisors

Receding mandibleReceding mandible

Protruding Maxillary Protruding Maxillary Incisors (buck teeth)Incisors (buck teeth)

ObesityObesity– Distribution, i. e. short, Distribution, i. e. short,

thick neck more thick neck more concerningconcerning

– Neck circumferenceNeck circumference

Thyromental distance: Thyromental distance: bony point on bony point on mentum (mandible) to mentum (mandible) to thyroid notchthyroid notch

If short (<3FB’s or If short (<3FB’s or 6cm), pharyngeal and 6cm), pharyngeal and laryngeal axis offlaryngeal axis off

Oropharyngeal visualizationOropharyngeal visualization

Mallampati ScoreMallampati Score

Sitting position, protrude tongue, don’t say Sitting position, protrude tongue, don’t say “AHH”“AHH”

Difficulty ventilatingDifficulty ventilating– Age >55Age >55– BeardBeard– History of snoringHistory of snoring– Lack of teethLack of teeth– BMI >26BMI >26

INTUBASI ENDOTRAKEALINTUBASI ENDOTRAKEAL

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

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Penentuan Ukuran ETTPenentuan Ukuran ETT

Orotrakeal intubationOrotrakeal intubation

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Nasotracheal intubationNasotracheal intubation

1.1. KrikotiroidotomiKrikotiroidotomi

2.2. TrakeostomiTrakeostomi

Indikasi:Indikasi: tidak dapat intubasi tracheatidak dapat intubasi trachea

-Edema Glottis-Edema Glottis

-Fractur laring-Fractur laring

-perdarahan oropharingeal berat -perdarahan oropharingeal berat

Surgical airwaySurgical airway

CricothyroidotomyCricothyroidotomy

Surgical cricothyroidotomySurgical cricothyroidotomy

TrakeostomiTrakeostomi

V. OKSIGENASI DAN V. OKSIGENASI DAN VENTILASIVENTILASI

ConclusionConclusion

Airway management is an extremely important Airway management is an extremely important aspect of the practice of anesthesiology and aspect of the practice of anesthesiology and critical carecritical care

Skills such as mask ventilation, endotracheal Skills such as mask ventilation, endotracheal intubation, are necessaryintubation, are necessary

DAFTAR PUSTAKADAFTAR PUSTAKA

Augusto Torres, MDAugusto Torres, MD, , Department of Department of AnesthesiologyAnesthesiology, , MetroHealth Medical MetroHealth Medical CenterCenter, 2011., 2011.

ATLS 2004.ATLS 2004.