7. Airway management and ventilation Flashcards
in the unconscious patient, where is the commonest site of airway obstruction?
the pharynx (most often at the soft palate and epiglottis rather than the tongue)
obstruction below the larynx is less common, but may be caused by ….
excessive bronchial secretions, mucosal oedema, bronchospasm, pulmonary oedema, aspiration of gastric contents
what do the following airway noises suggest about the level of the obstruction
1) inspiratory stridor
2) expiratory wheeze
3) gurgling
4) snoring
1) laryngeal level or above
2) lower airways, which tend to collapse and obstruct during expiration
3) liquid/ semisolid material in upper airways
4) pharynx is partially occluded by tongue or palate
what does see-saw breathing indicate?
complete airway obstruction - causes paradoxical chest and abdominal movement
how to manage airway obstruction in a pt with a permanent tracheostomy tube?
remove and foreign body from the stoma/ tube. Remove the liner (inner tube) if present. Pass a suction catheter if needed and attempt to ventilate while suctioning. If unable to pass a suction catheter, remove the tracheostomy tube and exchange if possible.
in a patient with a laryngectomy and permanent tracheal stoma, where should oxygen be delivered?
via the stoma, not the mouth
sequence for the treatment of a choking adult?
1) in mild obstruction
2) if signs of severe obstruction and pt conscious
3) if pt unconscious
1) encourage continued coughing and do nothing else
2) stand to the side and slightly behind, 5 back blows followed by 5 abdominal thrusts
3) call the resus team and start CPR. Once skilled person present, undertake laryngoscopy and attempt removal with Magill’s forceps
hand positioning for abominal thrust?
both arms round upper abdo with clenched first just under the xiphisternum
T/F: dentures should be left in place in a pt with airway obstruction
true- if well fitting as can help maintain the contours of the mouth, facilitating a good seal for ventilation
how to size a guedel?
vertical distance from pt’s incisors to the angle of the jaw
T/F: an oropharyngeal airway that is slightly too big will be more beneficial than one that is slightly too small
true
T/F: oropharyngeal airways should only be inserted in unconscious patients?
true - or can induce vomiting/ laryngospasm
T/F: known/ suspected BOS fracture is a complete contraindication to insertion of a nasopharyngeal airway?
false - oropharyngeal airway preferred but if not possible, and the airway is obstructed, a nasopharyngeal airway may be life saving (benefits outweigh risks)
how to size a nasopharyngeal airway?
no reliable method
size 6-7 suitable for most adults
risk if NPA is too long?
can stimulate the laryngeal or glossopharyngeal reflexes and produce laryngospasm or vomiting
what does a size 6mm NPA refer to ?
the internal diameter of the tube is 6mm
what level of oxygen should be used during CPR to ventilate the lungs?
there’s no data indicate optimal SaO2 so just use the highest feasible oxygen inspired concentration until ROSC achieved
a standard oxygen face mask will deliver up to ___% oxygen
50
a non-rebreather face mask can deliver an inspired oxygen concentration of ____% at flows of 10L/ min
85
what suction device should be used to remove liquid from upper airway?
yankauer (wide-bore rigid sucker)
T/F: the risk of transmitting SARS-COV-2 through mouth-to-mouth is extremely high
true - confirmed or suspected covid-19 is a contraindication to mouth-to-mouth ventilation
how much oxygen does a bag-valve mask deliver
1) when not attached to oxygen
2) when attached to high flow oxygen
1) 21% (atmospheric concentration)
2) 45% (of 85% if a reservoir system is attached)
what size igel for most adults?
4 (5 for tall, 3 for small)
how to insert i-gel?
hole side faced down (watch video)
how to confirm correct placement of the tracheal tube?
clinical assessment AND waveform capnography
what is the most serious complication of attempted tracheal intubation?
unrecognised oesophageal intubation
T/F: misting of the tracheal tube is a reliable indicator of correct placement
false - does little to confirm tracheal placement
T/F: waveform capnography has 100% specificity and sensitivity to identifying correct tracheal tube placement
true
T/F: waveform capnography will not differentiate between tracheal and bronchial placement of the tube
true
T/F: a tracheostomy is contraindicated in an emergency
true- instead use surgical circothyroidotomy (needle circothyroidotomy no longer recommended)
