airway & breathing management
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airway & breathing managementTRANSCRIPT
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AIRWAY & BREATHINGAIRWAY & BREATHINGMANAGEMENT MANAGEMENT
Anestesiologi dan ReanimasiRSUD Tasikmalaya
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POKOK BAHASANPOKOK BAHASAN
Bantuan pada sistem Respirasi :
– Airway yang bebas– Bantuan ventilasi bila napas spontan
tidak adekuat
– Suplemen O2
Alat-alat yang diperlukan untuktindakan diatas
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Airway Control
Membebaskan jalan napas
Prioritas utama pada
Obstruksi airway yang akut .
Obstruksi airway pasien tak sadar
o/k jatuhnya pangkal lidah
ke arah posterior.
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a. Pasien en!an res"irasi istres an #asi$ na"ass"ontan %
& 'eri(an s)"le#en O*
Bila +entilasi tia( ae()at % & 'eri(an 'ant)an +entilasi
'. Tana,tana % strior - rowin!
Cyanosis
/01 a(sesoris otot,otot "erna"asan
retra(si s)"rasternal2 interostal2 e"i!astri(
Har)s ian!!a" o'str)(si airway yan! (o#"lit
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Te$ni( )nt)( #e#'e'as(an
airway "aa (eaaan ini %C$in li3t 0 $ea tilt4aw t$r)st
Paa "asien tra)#aC.S"ine ontrol tan"a $ea tilt
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Head Tilt Chin Lift
Jaw Thrust
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Non tra)#aNon tra)#a airway #ane)+erairway #ane)+er Perta#a % $in li3tPerta#a % $in li3t
4aw t$r)st4aw t$r)st
Perla$an,la$an Hea tiltPerla$an,la$an Hea tilt
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Pasien,"asien en!an tra)#a %
C s"ine ontrol
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Bila en!an ara,ara iatas
/ tan"a alat 1 tia( 'er$asil
airway a5)nt
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Airway a5)ntAirway a5)nt
1. Oroparyngeal air way
2. !asoparingeal airway
". #ndotra$eal intubation
%. &ry$otyrotomy'. (ra$eostomy
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Oro"$aryn!eal airway
!ama lain : - )ayo
- *uedel
+ )emberikan ,asilitas untuk su$tioning
+ )en$ega endotrakeal tergigit pasien
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Oro"$arin!eal airwayOro"$arin!eal airway
• Sekret, darah, muntahan dibersihkan dulu
( Suction )
• Hanya untuk pasien-pasien tak sadar
omplikasi ! - menimbulkan obstruksi
- dapat menstimulasi muntah
dan spasme larin"
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6()ran Oro"$aryn!eal airway
!ang de"asa #
$esa! %k%!an # 5
&edi%m %k%!an # 4
Small %k%!an # 3
'a!a inse!si # ( dengan )ant%an *to%nge* s+atel
( disim+an te!)alik lal% di+%ta!
+e!la,an(la,an
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Teknik #nsersi $ropharyn"eal %irway
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Naso"$aryn!eal airway
+ tube tanpa $u,,dari plastik atau karet yang so,t lunak
+ dipili bila insersi oroparingeal sulit.
+ ole karena :
- trimus/- trauma masi, di mulut/
- interdental wiring
+ Alat ini 0uga berguna :
pasien-pasien yang napas
+ spontan dan masi semi$ons$ious
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Setiap setelah insersiSetiap setelah insersi pharyn"eal airwaypharyn"eal airway
( $ro naso )( $ro naso ) periksa respirasiperiksa respirasi
nafas ( - )nafas ( - )
bantuan nafas ( positi&e pressure )bantuan nafas ( positi&e pressure )
------------------------------------------------------------------------------------------ alat mouth to mouth to nosealat mouth to mouth to nose
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Naso"$aryn!eal airway
- Ukuran : dewasa : large 8 - 9
medium 7 - 8
mall ! - 7
- "eknik insersi :
• #ubrikasi
• Masukan lewat lubang hidung dst
- $omplikasi : masuk oesophagus distensi gaster
• laryngospasm dan muntah
• perdarahan hidung
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T'# #S'S# %S$*H%+'%L %#%+
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ada pasien-pasien diatas se$epatnya intubasi
Ke)nt)n!an %Ke)nt)n !an %+ perlindungan airway adekuat airway lebi
paten/ risiko aspirasi lebi rendamemungkinkan 3 $learing airway 3 adekuat+ memungkinkan pemberian O2 dengan
konsentrasi tinggi
+ bantuan ventilasi lebi adekuat volume tidakterkontrol
+ dapat sebagai salasatu pilian rute pemberianobat-obatan
Enotra$eal int)'asi
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4aktu memasang #(( :
lakukan penekanan pd krikoid ole orang ygmembantu intubasi
(u0uan : men$ega regurgitasi
Aspirasi
(ekanan dipertaankan sampai setela3 tube 3 masuk dan $u,, dikembangkan
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+ 5enti 0antung dan sedang dilakukankompresi 0antung luar
+ asien-pasien dengan ventilasi yang tidakadekkuat walaupun o.s. sadar
+ )elindungi airway koma/ are,le6ia/enti 0antung
+ (idak dapat diventilasi dengan adekuatdengan $ara-$ara yang konvensional padapasien-pasien yang tidak sadar
Ini(asi "e#asan!an ETT
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Hinari int)'asi 'ron$ial
Par),"ar) (anan sa5a "eri(sa s)ara na3as
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4an!an terlal) asi( int)'asi
Saat int)'asi na"as /,1
Bila terlalu lama pasien tdk bernapas
Hi"o(si st
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Ko#"li(asiKo#"li(asi IInt)'asint)'asi
gigi pata
bibir laserasi perdaraan
5ematom Ruptur tra$ea
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7.7. 8arin!os(o"8arin!os(o" , "eri(sa , la#")
- $ara memasang blade
* 5enis Blae %
, 8en!()n! % #aintos$ , 8)r)s / Strai!$t1 %
)iller/ 4is$onsin/ )agil
A8AT,A8AT YANG 9IPER86KAN
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Larin"oskop
.lade Len"kun"
Larin"oskop
.lade Lurus
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*.*. Enotra$eal t)'eEnotra$eal t)'e %%
– pipa terbuka dikedua u0ungnya
– bagian pro6imal konektor
– bagian distal $u,, yg dapat
dikembangkan melalui
3 one way in,lating valve 3– 7kuran : wanita 8 - 9 mm Orang Barat /
laki-laki 9 - 9/' mm Orang Barat
Sesuai dengan ; nternal ;iameter Saat suda intubasi tempat yg tepat : 2<-22 $m
tanda #((
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Stylet % - Membantu agar %"" dapat dibentuk sesuai kebutuhan
- &angan lupa lubrikasi
Alat,alat lain %
– S")it 7: / )nt)( #en!e#'an!(an )33 1
– ;ore"s Ma!ill– 8)'ri(ant
– S)tion )nit
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ALAT INTUBASI
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TEKNIK INT6BASITEKNIK INT6BASI %%
– Sia"(an an "eri(sa (e#'ali alat,alat yan! terseia
– Sia"(an "osisi (e"ala "enerita
< a(sis % #)l)t2 "$aryn=2 tra$ea
9ala# 7 !aris l)r)s a!ar +is)alisasi > #)a$
(e"ala e(tensi an le$er 3le=i
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Buka mulut dengan tangan kanan/ mulai
masukkan blade dari kanan digeser ketengasisikan lida kekiri.&ari epiglotis/ insersikan tip blade
di =alle$ula
angkat ke anterior>angan gunakan gigi depan sebagai ,ul$rum tumpuan Setela rimaglotis terliat insersikan #((
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Proses int)'asiProses int)'asi 5an!an le'i$ ari <: eti( 5an!an le'i$ ari <: eti(
// > 'ai( ? 7@ eti(> 'ai( ? 7@ eti( 11
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Antara int)'asi an int)'asiAntara int)'asi an int)'asi
// 'eri(an 'ant)an na3as'eri(an 'ant)an na3as 11
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ENTI8ASI
+ Resusitasi sinkron dengan kompresi 0antung luar
+ Bantuan =entilasi : 12 - 1' 6 ? menit
=olume tidal 9-1< $$?kg BB
*unakan O2 1<< @
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