Abcs Flashcards
Neutral position is for:
- initial assessment and management of the airway
- patients at risk of cervical spine injuries
(Maintains neutral anatomical alignment of the spinal column)
Sniffing position is for:
- patients requiring airway management
Head tilt, chin lift is for:
- Initial assessment and management of the airway
(Ideally combined with the neutral position during Initial assessment and management)
Lateral position is for:
- patients with altered conscious state not requiring active airway management
SGA indications
1) unconscious patient without gag reflex
2) ineffective ventilation with BVM and basic airway management
3) >10 minutes of assisted ventilation required
4) unable to intubate
SGA contras
- intact gag reflex or resistance on insertion
- strong jaw tone or trismus
- suspected epiglottis or upper airway obstruction
SGA precautions
- inability to prepare patient in the sniffing position
- patients who require high airway volumes
- vomit in airway
- paediatric patients who have enlarged tonsils
SGA side effects
Correct placement does not prevent passive regurgitation or gastric distension
NPA indications
Support airway patency in the unconscious patient
(NPA may be preferred in patients with trismus, gag reflex, oral trauma or in addition to other adjuncts)
NPA contras
NONE
NPA precautions
- facial fracture or basal skull fracture
(Any CSF from nares or ears = possibility of cerebral intrusion and only insert if absolutely necessary to maintain patent airway)
- TBI/nTBI
Stimulating a gag reflex in this group can significantly worsen ICP- only insert if absolutely necessary to maintain patent airway
NPA insertion and NOTES
- Select correct size by measuring corner of nose to earlobe
- lubricate distal end and insert into widest nostril at 90°
-An NPA is an adjuct that can assist with relieving anatomical obstruction
- the distal end once inserted is intended to displace the tongue and soft tissues anteriorly, relieving obstruction
- nasal pharyngeal may also be improved by widening/support of the nasal passage
- less likely to produce a gag reflex and can be used in patients with higher conscious states
-2 NPAs may be inserted
OPA indications
- support airway patency in the unconscious patient
- bite block in an intubated patient
OPA contras
-trismus
-gag reflex
-TBI/nTBI w/adequate ventilation/oxygenation (stimulating a gag reflex in this patient can worsen ICP)
OPA precautions
NONE
OPA procedure and NOTES
Measure from angle of jaw to middle of incisor (front teeth)
- hold opa by the flange and insert until halfway in = this is to clear the tongue to prevent pushing it back into the airway
- rotate 180° over tongue while continuing to insert
*if patient gags remove immediately
*incorrect size can exacerbate airway obstruction
Paediatrics
- Paediatric have softer palates more likely to be damaged by upside down insertion. A laryngoscope may be used to help opa past tongue
PEEP indications
- All patients receiving IPPV with cardiac output
- All neonates recieving IPPV
PEEP contras
-adult and paediatric patients in cardiac arrest = NO PULSE NO PEEP
- PEEP is indicated in neonate cardiac arrest to establish and maintain lung volume and improve oxygenation
PEEP Precautions
Patients with the below should be closely monitored for haemodynamic compromise/tension pneumothorax
- hypovolaemia/severe hypotension
- tension pneumothorax
- elevated ICP
- right ventricular failure
Triple airway manoeuvre is for:
Airway management and troubleshooting
- ideally combined with sniffing position or neutral position (if necessary)
3 steps of the triple airway manoeuvre are:
-head tilt
-jaw thrust
-open mouth
Bag Valve Mask indications:
- apnoea
- inadequate ventilations
Bag Valve Mask contras:
NONE
BVM grips x 3 are:
VE grip (vice grip) (2 ppl) = both thumbs on top of mask to secure, slightly bent and other fingers under lifting the jaw
- CE grip (1 person) = 1 hand C grip over mask, other hand for bvm
- Double CE (2 ppl) =2 hands securing mask to face
How to get a neutral position:
While supine elevate the patients head with the aim of bringing EXTERNAL AUDITORY MEATUS to the level of MID-CLAVICLE
2 to 5cm in most patients
- pads have prominent occiputs and short necks so may require thoracic elevation to achieve neutral head position
How to achieve SNIFFING position:
While supine elevate the patients head with the aim of bringing EXTERNAL AUDITORY MEATUS to level of MID STERNUM.
- this requires lower neck flexion and upper neck extension- with face parallel to the ceiling
- elevating the head of the stretcher can assist with achieving this position
Laryngoscopy indications:
Patients with Altered conscious state requiring inspection of the airway
Laryngoscopy contras:
NONE
How do we select the appropriately sized LARYNGOSCOPY blade?
-Place proximal aspect of blade at upper incisor (front teeth)
The tip of the blade should fall within 1cm of the angle of the mandible
Insertion for laryngoscopy:
- laryngoscope on pts left side head
- suction equipment on right side
- left hand grips base of handle
- right hand supports head
- open month
-insert blade down R/side - sweep tongue to the left side
Suction/remove foreign bodies as required
Nasogastric tube indications:
Following intubation or sga insertion
Nasogastic tube contras:
- severe middle facial fracture
- recent nasal surgery
- suspected basal skull fracture
- known oesophageal varices
Nasogastric tube precautions:
-coagulopathy
- advanced cirrhosis or liver failure (due to risks with oesophageal varices)
Nasal capnography indications:
- post sedation
- altered conscious state in the setting of drug or alcohol intoxication
NO CONTRAS
NO PRECAUTIONS
Nasal capnography NOTES. High and low readings?
nasal capnography measures the partial pressure of exhaled carbon dioxide in a spontaneous ventilating patient
Useful for: monitoring airway patency and identify trends in ETC02 value
HIGH ETC02 = hypercapnia (respiratory acidosis) low PH.
= Pt is hypoventilating and retaining too much C02 .
LOW ETC02= hypocapnia respiratory alkalosis) high PH
=PT is hyperventilating and blowing off too much C02
Oxygen cylinder presentations:
C cylinder = 400- 490 litres
D cylinder = 1500- 1650 litres
Oxygen side effects:
Drying of mucus members of the upper airway
SGA indications:
1) unconscious patient w/out a gag reflex
2) ineffective ventilation w/BVM and basic airway management
3) >10minutes of assisted ventilation required
4) Unable to intubate
SGA contras
- intact gag reflex
-strong jaw tone of trismus
-suspected epiglottis or upper airway obstruction
SGA precautions:
-inability to prepare patient in the sniffing position
- patients who require higher airway volumes
- vomit in airway
-paeds who have enlarged tonsils
SGA troubleshooting:
If early resistance encounter or inadequate seal- correct with:
-clockwise/anti clockwise rotation while exerting downward pressure
AND/OR
Jaw thrust while inserting/reinserting.
MAX 3 attempts
Suction indications:
Suspected fluid obstruction in the airway or airway device
Suction contras
NONE
Suction precautions:
-epiglottis
(extremely caution, stimulation of the epiglottis may cause complete airway obstruction.
- Croup
Does not require routine suction and may worsen swelling and distress
3 types of suction equipment:
- Y suction
Best for ETT, NPA, STOMA OROPHARYNGEAL, NEONATE suction - Yankauer
Best for visible secretions fluids in the oropharynx or external nares - Ducanto
Best for large volume regurgitation, emesis or bleeding particularly during intubation
How does the triple airway manoeuvre enhance the assessment of the airway:
The aim is to life the soft tissue away from the posterior wall of the oropharynx, relieving the obstruction of the airway.
How bloody good is Rachel for making this:
10/10 bloody fantastic!!
