Advanced Airway - Choking

Question 1

Review the airway anatomy

Answer 1

Question 2

What are the airway positions

Answer 2

• 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)

Question 3

What is the triple airway manoevre?

Answer 3

• head tilt
• chin lift
• jaw thrust

Question 4

What are some airway adjuncts

Answer 4

• NPA
• OPA
• LMA
• ETT

Question 5

What are the indications for OPA?

Answer 5

• support airway patency in the unconscious patient

Question 6

What are the contraindications for OPA?

Answer 6

• trismus
• gag reflex
• TBI/nTBI with adequate ventilation/oxygenation

Question 7

How do you measure an OPA?

Answer 7

• measure from angle of jaw to middle of the incisor

Question 8

What are the sizes of NPA?

Answer 8

• 6.5
• 7.5

Question 9

How do you correctly size an NPA?

Answer 9

• from the nare of the nose to the middle ear

Question 10

What are some indications for NPA?

Answer 10

• support airway patency in the unconscious patient

Question 11

What are the contraindications for an NPA?

Answer 11

• none

Question 12

What are some precautions of NPA?

Answer 12

• facial #’s
• suspected BOS #
• TBI/nTBI

Question 13

Why are we cautious inserting an NPA/OPA in TBI/nTBI patients?

Answer 13

stimulate gag reflex = increase ICP
only insert if necessary

Question 14

What are the indications for laryngoscope?

Answer 14

• ACS
• NO airway reflexes
• inspection of airway required

Question 15

How do you perform an laryngoscope?

Answer 15

• 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

Question 16

You are having trouble viewing the FB during laryngoscope, what are some things you can do to trouble shoot the patient (head)

Answer 16

• right lip protraction
• additional head elevation
• is my head and body position appropriate
• mandibular placement

Question 17

You are having trouble viewing the FB during laryngoscope, what are some things you can do to trouble shoot the patient (scope)

Answer 17

• is the laryngoscope blade length adequate
• Is the tongue positioned to the left
• cani directly lift the epiglottis
• is extra lift required?

Question 18

what are the indications for SGA?

Answer 18

• unconscious patient without a gag reflex
• ineffective ventilation with a BVM and basic airway management
• > 10 mins assisted ventilations
• unable to intubate

Question 19

What are the contraindications of a SGA

Answer 19

• intact gag reflex or resistance to insertion
• strong jaw tone and/or trismus
• suspected epiglottitis or upper airway obstruction

Question 20

What are some precautions of SGA insertion

Answer 20

• 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

Question 20

What are some precautions of SGA insertion

Answer 20

• 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

Question 21

define choking

Answer 21

• 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

Question 22

describe stridor

Answer 22

• 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

Question 23

what do you do if your patient is choking but they are conscious with an effective cough?

Answer 23

• allow patient to choose preferred position
• encourage to cough
• monitor for deterioration/removal of obstruction

Question 24

What do you do if your patient is choking with an absent or ineffective cough

Answer 24

• visual inspection
• position head low/laterally
• manually clear as required (finger sweep)

Question 25

What do you do if after initial interventions your patient is still choking

Answer 25

• 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)

Question 26

Besides FB’s what are some other things that can cause obstruction?

Answer 26

• tongue
• ACE inhibitors (reaction)
• Croup
• Epiglottitis
• Tonsilitis

Question 27

what is the patho of non fatal drowning?

Answer 27

Question 28

what is the patho of non fatal drowning?

Answer 28

– 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

Question 29

What are some potential complications of trachy’s

Answer 29

• acute airway obstruction (most common)
• blocked tube
• infection
• aspiration
• tracheal trauma
• dislodged tube
• tracheal stenosis