ABCDE airway

Question 1

when assessing the airway in ABCDE, what are you looking for? interventions?

Answer 1

verbal repsonse = airway is fine

look: check patency of airway/for anything blocking the airway, cyanosis, see-saw bretahing

listen: stridor, diminished breath sounds, snoring, gurgling, wheeze

feel: for warm air coming out the mouth

Question 2

what is see-saw bretahing?

Answer 2

it is where instead of the chest and abdomen both rising during inspiration, the abdomen rises but the chest is drawn in

it is associated with partial and complete airway obstruction

Question 3

causes of airway compromise?

Answer 3

Blocked with stuff you can remove: IFB, blood, vomit

Blocked with tissue: anaphylaxis, infection eg quinsy, epiglottitis, croup, local mass effect, laryngospasm eg asthma, gord, intubation

Depressed consciousness eg opioid overdose, head injury, stroke

Question 4

when should you never use a nasopharyngeal airway

Answer 4

They should not be used in patients with suspected base of skull fracture.

Question 5

features severe obstruction choking

Answer 5

The patient being unable to breathe or speak/vocalise.
Wheezy breath sounds.
Attempts at coughing that are quiet or silent.
Cyanosis and diminishing conscious level (particularly in children).
The patient being unconscious.

Question 6

management of choking

Answer 6

“are you choking?”
“I can see that you’re choking, I am here to help you, try and cough hard…”
“i will intervene if it doesn’t come up”

Severe obstruction in a conscious child/adult
5 back blows
5 abdominal thrusts (heimlich)
Repeat

Severe obstruction in a baby
5 back blows
5 chest thrusts
Repeat

Unconscious patient
Lower patient to the floor
Begin CPR

Question 7

most common site for inhaled foreign body to settle

Answer 7

The right bronchial system is more frequently involved than the left due to its more vertical orientation.

Question 8

complications inhlaed foreign body?

Answer 8

Aspiration can lead to mechanical obstruction of airflow resulting in atelectasis distal to the obstruction site or air trapping proximally with subsequent hyperinflation.

Additionally, inflammatory reactions may develop around the foreign body leading to granulation tissue formation and potential infection.

Question 9

management pt with inhaled foreign body

Answer 9

supportive and:

Bronchoscopy for removal of the foreign body.

Question 10

what can cause airway obstruction in children

Answer 10

croup
epiglottitis
laryngomalacia
inhaled foreign body

Question 11

define anaphylaxis

Answer 11

the sudden onset and rapid progression of symptoms
Airway and/or Breathing and/or Circulation problems
Airway problems may include:
swelling of the throat and tongue →hoarse voice and stridor
Breathing problems may include:
respiratory wheeze
dyspnoea
Circulation problems may include:
hypotension
tachycardia

This means that if there are no ABC problems then the patient is technically not having anaphylaxis.

Question 12

what skin and mucosal changes may someone with anaphylaxis have?

Answer 12

Around 80-90% of patients also have skin and mucosal changes:
generalised pruritus
widespread erythematous or urticarial rash

Question 13

management of anaphylaxis?

Answer 13

IM adrenaline injection -anterolateral aspect of the middle third of the thigh

adult and >12
500 micrograms (0.5ml 1 in 1,000)

Adrenaline can be repeated every 5 minutes if necessary.

Question 14

define refractory anaphylaxis

Answer 14

defined as respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline

IV fluids should be given for shock

expert help should be sought for consideration of an IV adrenaline infusion

Question 15

management of anaphylaxis following stabilisation

Answer 15

non-sedating oral antihistamines in patients with persisting skin symptoms (urticaria and/or angioedema)

all patients with a new diagnosis of anaphylaxis should be referred to a specialist allergy clinic

an adrenaline injector should be givens an interim measure before the specialist allergy assessment (unless the reaction was drug-induced)
patients should be prescribed 2 adrenaline auto-injectors
training should be provided on how to use it

observationfor appropriate amount of time eg 2 hours, 6 hours or 12 hours

Question 16

what should you check if someone has ?anaphylaxis but its not clear if correct dx

Answer 16

Serum tryptase levels are sometimes taken in such patients as they remain elevated for up to 12 hours following an acute episode of anaphylaxis

Question 17

what is the reason for a risk-stratified approach to discharge mean anaphylaxis

Answer 17

a risk-stratified approach to discharge should be taken as biphasic reactions can occur in up to 20% of patients

Question 18

when can someone with anaphylaxis be discharged after 2 hours of symptom resolution?

Answer 18

good response to a single dose of adrenaline
complete resolution of symptoms
adequate supervision following discharge

(+autoinjectors etc)

Question 19

when should someone with anaphylaxis be discharged after 6 hours symptom reoslution

Answer 19

2 doses of IM adrenaline needed, or
previous biphasic reaction

Question 20

when should someone be discharged after a minimum of 12 hours after symptom resolution anaphyalxis

Answer 20

severe reaction requiring > 2 doses of IM adrenaline
patient has severe asthma
possibility of an ongoing reaction (e.g. slow-release medication)
patient presents late at night
patient in areas where access to emergency access care may be difficult
observation for at 12 hours following symptom resolution

Question 21

management opiod overdose reduced consciousness/compromised airway

Answer 21

airway management

IV or IM naloxone :
Rapid onset and short half life so need more than one dose often
Initially 400 micrograms
then 800 micrograms for up to 2 doses at 1-minute intervals
if no response to preceding dose, then increased to 2 mg for 1 dose if still no response (4 mg dose may be required in seriously poisoned patients)

Question 22

causes of audible wheeze

Answer 22

This signifies narrowing of the tracheobronchial tree through either bronchospasm or becoming flooded with fluid

eg asthma or pulmonary oedema

Question 23

interventions airway

Answer 23

intervene:
2222 if airway problem - need anaethetist

Head-tilt chin lift/jaw thrust (If the patient is suspected to have suffered significant trauma with potential spinal involvement, perform a jaw-thrust rather than a head-tilt chin-lift manoeuvre)

suction if anything visible in airway or there is gurgling - get pt to sit upright and take deep breaths

airway adjuncts (nasopharyngeal, oropharyngeal, i-gel)

Question 24

Clinical presentation laryngospasm

Answer 24

People with laryngospasm are unable to speak or breathe. Many describe a choking sensation. This is because your vocal cords are contracted and closed tight during a laryngospasm.

Preceded by high pitched inspiratoria stridor