Securing the airways (half heels)

From WikiLectures

Motto Dum spiro, spero. or loosely translated As long as the patient breathes, one can hope.

Securing the airway is a skill required of every person. With the level of education, it is necessary to increase the level of one's skill. Basic is a simple tilt . Maintaining the patency of the airways and maintaining the exchange of respiratory gases is a condition of life. The key place is the area from the root of the tongue to the rings of the trachea .

If the airway needs to be secured, you usually have little time to choose a method and perform the procedure. It cannot be expected with certainty that the first method chosen will be feasible or sufficient. Holding a mask cannot be learned from a picture, and intubation is a procedure mastered after about 20 attempts. During 50 to 100 intubations, you will encounter a "can't intubate, can't ventilate" situation, when it is necessary to use alternative methods (from laryngeal mask to coniopuncture).

Why the airway must be secured (indications)[edit | edit source]

Performing intubation
  • Developed or worsening impairment of consciousness (including analgosedation and surgery).
  • Exhaustion from excessive work of breathing during respiratory failure.
  • Obstruction of the upper respiratory tract (facial injury, swelling of the tongue, laryngospasm ).

What options do we have, some advantages and disadvantages, the method of choice[edit | edit source]

Attention - the list of advantages and disadvantages is not exhaustive!

Recovery position:

+ without the need to be present with the patient, reduces the risk of aspiration of stomach contents;
– spontaneous breathing must be sufficient.

Tilt, forward jaw:

+ necessary skill to perform other methods;
– spontaneous breathing must be sufficient.

Breathing mask:

+ necessary skill to perform other methods, enables emergency positive pressure breathing ;
– use of both hands, poorly functional in patients without teeth, obese, facial injuries.

Laryngeal mask with rigid bent tube:

+ emergency option in case of intubation failure, can be introduced from the front, in a semi-sitting position, without leaning back, opening the mouth to 2 cm between the incisors, possibility of use by trained non-medical personnel, possibility of emergency artificial ventilation;
− the possibility of easy luxation of the mask from the correct position.
  • Similarly, other supraglottic devices ( combitube , laryngeal tube) - intended mainly for use by trained non-medical personnel.
  • Laryngeal masks with a flexible, straight tube are preferably used in anesthesiology rooms, their introduction requires practice.
  • All of the above methods do not prevent aspiration of gastric contents and do not allow major changes in the patient's position.

Endotracheal intubation:

Intubation with video laryngoscope
+ prevention of aspiration, the possibility of pressurized breathing and changes in position;
− mostly necessary administration of muscle relaxants , high current resistance during spontaneous ventilation.


+ entry into the airways below critical points (glottis, epiglottis);
− invasive procedure.

Ducts are omitted from this list for limited benefit. Tracheostomy is a surgical intervention requiring preliminary securing of the airways.

Some points in the intubation process[edit | edit source]

Course of laryngoscopy
  • Preparation of a wide tube suction cup and other aids.
  • Checking the brightness of the laryngoscope.
  • Inspection of the introducer (the tip of the introducer must not protrude from the tube).
  • Preoxygenation (minimum 2 minutes or 3 breaths, oxygen flow above 13 L/min or reservoir).
  • Sellick palpation for fear of regurgitation.
  • Relaxation check by pulling on the chin - we detect the relaxation of the masticatory muscles.
  • Laryngoscope in left hand, we enter in the right corner.
  • Introduce with an arcing motion, then pull up, dislike.
  • Protect the incisors .
  • Work on your own exhalation, try not to extend it for more than 15 seconds.
  • When glottis ligaments are seen, keep pulling on the laryngoscope and check the penetration of the balloon.
  • After insertion, fix the tube with your fingers in the right corner until its final fixation with a patch (bandage, fixator).
  • To inflate the balloon, only now to release Sellick's touch.
  • Ventilation, storage control by triple listening, fogging, capnometry.

Links[edit | edit source]

Related Articles[edit | edit source]

  • Securing the airway during anesthesia
  • Artificial lung ventilation
  • Endotracheal intubation
  • Crush introduction to anesthesia
  • Difficult intubation

Recommended literature and texts[edit | edit source]

External links[edit | edit source]