abordaje de via aerea Flashcards
what are some basic airway equipment
oropharyngeal airway (OPA) and nasopharyngeal airway (NPA)
- both terminate in the pharynx
- NPA doesn’t stimulate gag reflex
what are some advanced airway equipment
laryngeal mask
laryngeal tube
esophageal-tracheal tube
endotracheal tube
characteristics of an oropharyngeal airway (OPA)
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
characteristics of a nasopharyngeal airway
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
when should suctioning the airway be indicated
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
basic airway technique when inserting an OPA
- clear mouth, suction if needed
- select correct size
- place device ad side of pts face, the correct size measures extends from corner of mouth to earlobe - insert device into mouth with point up
- once device is almost fully inserted, rotate the device until the tongue is cupped by the interior curve of the device
basic airway technique when inserting a NPA
- 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 - lubricate airway with water-soluble lubricant or anesthetic jelly
- 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
whats the rate of breathing when an advanced airway is placed during CPR
one breath every 6 - 8 seconds
what are some objective signs of airway obstruction
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
what are some objective signs of inadequate ventilation
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
what is the mallampati classification used for
to visualize the hypopharynx
what is a class I mallampati classification
soft palate, uvula, fauces, pillars visible
what is a class II mallampati classification
soft palate, uvula, fauces visible
what is a class III mallampati classification
soft palate, base of uvula visible
what is a class IV mallampati classification
hard palate only visible
what kind of intubation is indicated if the pt has apnea
orotracheal intubation
what are the most important determinants of wheter to proceed with orotracheal or nasotracheal intubation
the experience of the clinician and the presence of a spontaneously breathing pt
T/F. Blind nasotracheal intubation requires a pt who is spontaneaously breathig and is contraindicated in pt with apea
TRUE
what are relative contraindications to nasotracheal intubation
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)
what are some forms of endotracheal intubation
orotracheal
nasotracheal
what is the technique for rapid sequence intubation (RSI)
- 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
- ensure that suction and the ability to deliver + pressure ventilation are ready
- preoxygenate the pt with 1-00% O2
- apply pressure over the cricoid cartilage
- admin. an induction drug (etomidate 0.3mg/kg) or sedate, according to local practice
- admin 1 - 2 mg/kg succinylcholine IV (usual dose is 100mg)
- after pt relaxes, intubate the pt orotracheally
- inflate the cuff and confirm tube placement by auscultating the pt’s chest and determining the presence of CO2 in exhaled air
- release cricoid pressure
- ventilate the pt
what are examples of a surgical airway
cricothyroidotomy
tracheostomy
when should a surgical airway be established
- edema of the glottis
- fracture of the larynx
- severe oropharyngeal hemorrhage obstructs airway
- endotracheal tube can’t pass vocal cords
what is the preferred surgical airway and why
cricothyroidotomy
it is easier to perform, associated with less bleeding, and requires less time to perform than an emergency tracheostomy
