Airway Flashcards
Laryngoscope Indications
Pt in altered conscious state, requiring inspection of airway
Laryngoscope Contraindications
Nil
Laryngoscope Precautions
nil
Nasopharyngeal Airway Indications
Support airway patency in the unconscious pt. May be preferable in pts with trismus, gag reflex, oral trauma, or in addition to other airways.
Nasopharyngeal Airway Contraindications
None
Nasopharyngeal Airway Precautions
- Facial fractures and suspected basal skull fractures (any CSF from nares or ears)
- TBI/nTBI - gag reflex can worsen ICP. only use if absolutely necessary.
Oropharyngeal Airway (OPA) Indications
- Unconscious pt with where there is a need to maintain airway patency
- Bite block in the intubated pt
OPA Contraindications
- Trismus
- Gag reflex
- TBI/nTBI with adequate ventilation/oxygenation
OPA precautions
nil
Management of choking pt
- Encourage pt to cough
- Manual airway clearance
- 5 back blows and 5 chest thrusts alternated
- Laryngoscopy/Magills/Suction
- 5 ventilations and 5 compressions
- Alternate 5 compressions and airway inspection until obstruction resolves/pt arrests
Indications of LMA
- Unconscious pt without gag reflex
- Ineffective ventilation with BVM and basic airway management
- > 10 minutes assisted ventilations required
- Unable to intubate
Contraindications of LMA
- Intact gag reflex or resistance to insertion
- Strong jaw tone or trismus
- Suspected epiglotittis or upper airway obstruction
- The use of sedation to assist placement is contraindicated
Precautions of LMA
- Inability to prepare pt into sniffing position
- Pts who require high airway pressures (advanced pregnancy, morbid obesity, decreased pulmonary compliance, increased airway resistance ie severe asthma)
- Paediatric pts with enlarged tonsils
- Vomit in the airway
FAT KIDS SNIFF VOMIT
LMA sizes
Orange - size 5 - 90kgs+ - gastric tube size 14
Green - size 4 - 50-90kgs - gastric tube size 12
Yellow - size 3 - 30-60kgs - gastric tube size 12
CPAP contraindications
- Altered conscious state
- Active vomiting/excess secretions
- UAO
- Hypoventilation
- TPT that is untreated
- Haemodynamic instability (severe hypotension, untreated ventricular arrhythmias)
- Airway management required
- Injuries precluding mask application
CPAP Precautions
Pts with the following should be monitored for TPT or haemodynamic compromise following CPAP:
- Hypovolaemia
- post chest decompression
- RVF
How many litres of O2 flow required for CPAP and what pressure do we want to achieve?
Minimum 8 litres/min
Adjust oxygen flow meter until a pressure of 10 cmH2O is
obtained. Do not exceed this.
A flow rate of 12-14 L/min will typically be
required.
Oxygen - Critical Illness
Initial high flow - then titrate for:
- Cardiac arrest
- Major trauma/head injury
- Shock
- Severe sepsis
- Anaphylaxis
- Status Epilepticus
- Ketamine Sedation
Oxygen - Chronic Hypoxaemia Conditions
Titrate o2 to 88-92% for:
- COPD
- Neuromuscular disorders
- Cystic fibrosis
- Bronchiectasis
- Severe kyphoscoliosis
- Obesity
Oxygen - Conditions requiring constant high flow O2
High flow o2 regardless of SpO2 for:
- Toxic inhalation exposure
- Decompression illness
- Cord prolapse
- Postpartum haemorrhage
- Shoulder dystocia
- Cluster headache
Suction Indications
Suspected fluid obstruction in airway or airway device
Suction precautions
- Epiglottitis - stimulation may cause complete obstruction
- Croup - does not normally need suction. May worsen swelling and distress
Suction contraindications
nil
BVM indications
- Apnoea
- Hypoventilations
