Advanced Airway - Choking Flashcards
Review the airway anatomy
What are the airway positions
- lateral airway posture
- sniffing position
- head tilt
- neutral anatomical position (padding under head in adult)
- neutral anatomical position for infant/small child (padding under shoulders/back)
- ## Neutral anatomical position for larger child (no padding)
What is the triple airway manoevre?
- head tilt
- chin lift
- jaw thrust
What are some airway adjuncts
- NPA
- OPA
- LMA
- ETT
What are the indications for OPA?
- support airway patency in the unconscious patient
What are the contraindications for OPA?
- trismus
- gag reflex
- TBI/nTBI with adequate ventilation/oxygenation
How do you measure an OPA?
- measure from angle of jaw to middle of the incisor
What are the sizes of NPA?
- 6.5
- 7.5
How do you correctly size an NPA?
- from the nare of the nose to the middle ear
What are some indications for NPA?
- support airway patency in the unconscious patient
What are the contraindications for an NPA?
- none
What are some precautions of NPA?
- facial #’s
- suspected BOS #
- TBI/nTBI
Why are we cautious inserting an NPA/OPA in TBI/nTBI patients?
stimulate gag reflex = increase ICP
only insert if necessary
What are the indications for laryngoscope?
- ACS
- NO airway reflexes
- inspection of airway required
How do you perform an laryngoscope?
- check correct patient position (neutral or sniffing)
- check suction and magills foreceps ready and available
- insert into R) side of mouth, sweeping tongue towards the left
- Look L) and R) for foreign material in oropharynx
You are having trouble viewing the FB during laryngoscope, what are some things you can do to trouble shoot the patient (head)
- right lip protraction
- additional head elevation
- is my head and body position appropriate
- mandibular placement
You are having trouble viewing the FB during laryngoscope, what are some things you can do to trouble shoot the patient (scope)
- is the laryngoscope blade length adequate
- Is the tongue positioned to the left
- cani directly lift the epiglottis
- is extra lift required?
what are the indications for SGA?
- unconscious patient without a gag reflex
- ineffective ventilation with a BVM and basic airway management
- > 10 mins assisted ventilations
- unable to intubate
What are the contraindications of a SGA
- intact gag reflex or resistance to insertion
- strong jaw tone and/or trismus
- suspected epiglottitis or upper airway obstruction
What are some precautions of SGA insertion
- inability to prepare patient into sniffing position
- pts who require high airway pressures (advanced pregnancy, morbid obesity, pulmonary fibrosis) or increased airway resistance (asthma)
- paediatric patients due to enlarged tonsils (MICA only)
- significant volume of vomit in airway
- correct placement of IGEL, does not prevent passive regurgitation
What are some precautions of SGA insertion
- inability to prepare patient into sniffing position
- pts who require high airway pressures (advanced pregnancy, morbid obesity, pulmonary fibrosis) or increased airway resistance (asthma)
- paediatric patients due to enlarged tonsils (MICA only)
- significant volume of vomit in airway
- correct placement of IGEL, does not prevent passive regurgitation
define choking
- any abnormal condition of the mouth, nose or larynx that causes a mechanical impedement to the delivery of air to the lungs, when most of the respiratory system is functioning normally
- can be partial/complete/resolved
describe stridor
- high pitched sound that occurs with obstruction in or just below the larynx
- usually loudest on inspiration (can be exhalation also)
- common in children due to their narrow airways
- can be a sign of immediate life threat
- potential to occlude airway
what do you do if your patient is choking but they are conscious with an effective cough?
- allow patient to choose preferred position
- encourage to cough
- monitor for deterioration/removal of obstruction
What do you do if your patient is choking with an absent or ineffective cough
- visual inspection
- position head low/laterally
- manually clear as required (finger sweep)
What do you do if after initial interventions your patient is still choking
- Back blows x 5 (between the scapula) lean over chair/bed
- Chest thrusts x 5 (not in newborns), have back against something hard
last resort = cricothyroidotomy (MICA)
Besides FB’s what are some other things that can cause obstruction?
- tongue
- ACE inhibitors (reaction)
- Croup
- Epiglottitis
- Tonsilitis
what is the patho of non fatal drowning?
what is the patho of non fatal drowning?
– small amount of water entering the lungs during an immersion or submersion event – inflammatory response leading to altered alveolar capillary permeability.
- This in turn causes irritation to the lining of the lungs, and interstitial fluid shifts into the alveoli. Surfactant is washed out, leading to a loss of surface tension = APO.
patients can present up to 72 hours post drowning
What are some potential complications of trachy’s
- acute airway obstruction (most common)
- blocked tube
- infection
- aspiration
- tracheal trauma
- dislodged tube
- tracheal stenosis
