abordaje de via aerea

Question 1

what are some basic airway equipment

Answer 1

oropharyngeal airway (OPA) and nasopharyngeal airway (NPA)

• both terminate in the pharynx
• NPA doesn’t stimulate gag reflex

Question 2

what are some advanced airway equipment

Answer 2

laryngeal mask
laryngeal tube
esophageal-tracheal tube
endotracheal tube

Question 3

characteristics of an oropharyngeal airway (OPA)

Answer 3

J shaped device that fits over the tongue to hold the soft hypopharyngeal structures and the tongue away from the posterior wall of the pharynz

USE ONLY IN AN UNCONSCIOUS PT

Question 4

characteristics of a nasopharyngeal airway

Answer 4

soft rubber or plastic uncuffed tube that provides a conduct for airflow between the nares and the pharynx

use caution or avoid in pt with facial fractures

can be used in conscious or semiconscious pts

use lubricant to facilitate placemente

be gentle to avoid nosebleeds

Question 5

when should suctioning the airway be indicated

Answer 5

immediately if there are copious secretions, blood, or vomit

attempts at suctioning shouldn’t >10 seconds

to avoid hypoxemia follow suctioning attempts with a short period or 100% oxygen

monitor HR, O2 sat., and clinical appearance during suctioning

dont insert catheter too deply, extend catheter to max depth and suction as you withdraw

Question 6

basic airway technique when inserting an OPA

Answer 6

1. clear mouth, suction if needed
2. select correct size
   - place device ad side of pts face, the correct size measures extends from corner of mouth to earlobe
3. insert device into mouth with point up
4. once device is almost fully inserted, rotate the device until the tongue is cupped by the interior curve of the device

Question 7

basic airway technique when inserting a NPA

Answer 7

1. select device with correct size
   - place side at side of pts face, the correct size extends from tip of the nose to the earlobe
   - use largest diameter device that will fit
2. lubricate airway with water-soluble lubricant or anesthetic jelly
3. insert device slowly (dont force it), moving it straight towards the face (at a 90º angle)
   - if it feels stuck, remove it and try the other nostril

Question 8

whats the rate of breathing when an advanced airway is placed during CPR

Answer 8

one breath every 6 - 8 seconds

Question 9

what are some objective signs of airway obstruction

Answer 9

observe pt to determine whether pt is:

• agitated: suggests hypoxia
• obtounded: suggests hypercarbia
• cianosis: indicates hypoxemia
• look for retractions and the use of accessory muscles of ventilation

listen for abnormal sounds
- noisy breathing is obstructive breathing

use a pulse oximeter

fell the location of the trachea and quickly determine whether it is in the midline position

evaluate pt behavior
- abusive and belligerent pt may in fact have hypoxia and shouldn’t be presumed to be intoxicated

Question 10

what are some objective signs of inadequate ventilation

Answer 10

look for symmetrical rise and fall of the chest and adequate chest wall escursion

• asymmetry suggests splinting ot the rib cage or a flail chest
• labored breathing my indicate an imminent threat to the pt’s ventilation

listen for movement of air on both sides of the chest
use a pulse oximeter

Question 11

what is the mallampati classification used for

Answer 11

to visualize the hypopharynx

Question 12

what is a class I mallampati classification

Answer 12

soft palate, uvula, fauces, pillars visible

Question 13

what is a class II mallampati classification

Answer 13

soft palate, uvula, fauces visible

Question 14

what is a class III mallampati classification

Answer 14

soft palate, base of uvula visible

Question 15

what is a class IV mallampati classification

Answer 15

hard palate only visible

Question 16

what kind of intubation is indicated if the pt has apnea

Answer 16

orotracheal intubation

Question 17

what are the most important determinants of wheter to proceed with orotracheal or nasotracheal intubation

Answer 17

the experience of the clinician and the presence of a spontaneously breathing pt

Question 18

T/F. Blind nasotracheal intubation requires a pt who is spontaneaously breathig and is contraindicated in pt with apea

Answer 18

TRUE

Question 19

what are relative contraindications to nasotracheal intubation

Answer 19

facial, frontal sinus, basilar skull, and cribiform plate fractures

signs of these injuries: evidence of nasal fracture, raccoon eyes (bilateral ecchymosis in the periorbital region), Battle’s sign (postauricular ecchymosis) and possible CFS leaks (rhinorrea or otorrhea)

Question 20

what are some forms of endotracheal intubation

Answer 20

orotracheal

nasotracheal

Question 21

what is the technique for rapid sequence intubation (RSI)

Answer 21

1. have a plan in the event of failure that includes the possibility of performing a surgical airway. Know when your rescue airway equipment is located
2. ensure that suction and the ability to deliver + pressure ventilation are ready
3. preoxygenate the pt with 1-00% O2
4. apply pressure over the cricoid cartilage
5. admin. an induction drug (etomidate 0.3mg/kg) or sedate, according to local practice
6. admin 1 - 2 mg/kg succinylcholine IV (usual dose is 100mg)
7. after pt relaxes, intubate the pt orotracheally
8. inflate the cuff and confirm tube placement by auscultating the pt’s chest and determining the presence of CO2 in exhaled air
9. release cricoid pressure
10. ventilate the pt

Question 22

what are examples of a surgical airway

Answer 22

cricothyroidotomy

tracheostomy

Question 23

when should a surgical airway be established

Answer 23

• edema of the glottis
• fracture of the larynx
• severe oropharyngeal hemorrhage obstructs airway
• endotracheal tube can’t pass vocal cords

Question 24

what is the preferred surgical airway and why

Answer 24

cricothyroidotomy

it is easier to perform, associated with less bleeding, and requires less time to perform than an emergency tracheostomy