Airway Flashcards
First step in assessing a patient
Airway management
Upper airway consists of:
Nasal cavity
Pharynx
Larynx
Lower Airway consists of:
Trachea, it’s branches, and the lungs
Primary control centers come from the:
Medulla
Pons
Primary involuntary respiratory center
Medulla
Connected to the respiratory muscles by the vagus nerve
Pons
Chemical stimuli - receptors for oxygen and carbon dioxide balance are located:
Carotid bodies (carotid sinus)
Aortic arch
Primary control of respiratory center stimulation
Cerebrospinal (CSF) pH
CSF is affected by the:
Amount of carbon dioxide in the body
Form of respiratory drive in which the body uses oxygen
Hypoxic Drive
Patients who are somewhat dependent on a hypoxic drive to breath normally only saturate at around ___% oxygenation
90-92%
Factors that increase respiration
Body temperature
Emotion
Pain
Hypoxia
Acidosis
Stimulant drugs
Factors that decrease respiration
Depressant drugs, Sleeping agents
Morphine
When there is no oxygen available at all
Anoxia
SaO2
Arterial oxygen saturation
PaO2
Arterial oxygen tension
Is the fraction or percentage of oxygen in the space being measured.
Used to represent the percentage of oxygen the patient is breathing
Fraction of inspired oxygen (FiO2)
Literally means “deficient in oxygen”, that is an abnormally low oxygen availability to the body or an individual tissue or organ
Hypoxia
Insufficient oxygenation; that is decreased partial pressure of oxygen in blood
Hypoxemia
Non-invasive method allowing the monitoring of the saturation of a patient’s hemoglobin
Pulse oximeter
Pulse ox
Normal readings
95-100%
Pulse ox
Values under ___ are considered low and a clinical emergency
90%
Nasal canula O2 rate
1-4 L/min
Inspired concentration: 25-30%
Handheld device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately
Bag-Valve Mask
Complete control over the composition of the inspired gas is available.
Ventilator
Hyperbaric Oxygen.
100% oxygen is given at an increased pressure of 3 atm. Since normal air is 20% oxygen, pure oxygen would be 5 times more oxygen, and at 3 times normal air pressure, a patient gets ___ times more oxygen than normal.
15 times
Indications for hyperbaric oxygen
Decompression illness
Carbon monoxide poisoning
Radiation necrosis
Reconstructive surgery
Some infection wounds
Results from the long-term exposure to partially reduced oxygen products which alter the metabolic function and structure of lung cells
Oxygen toxicity
Takes precedence over all other procedures, with the exception of massive bleeding
Management of the airway
Most common cause of airway obstruction
Tongue
Maneuvers that move the flaccid tongue out of the airway / opens the airway
Head Tilt/Chin Lift
Jaw Thrust
Maneuver is used to relieve a variety of anatomic airway obstructions in casualties who are breathing spontaneously.
The chin and lower incisors are grasped and then lifted to pull the mandible forward.
Head Tilt/Chin Lift
In casualties with suspected head, neck, or facial trauma, the cervical spine is maintained in a neutral inline position
Allows the provider to open the airway with little or no movement of the head and cervical spine.
Jaw Thrust Maneuver
Maneuver that aids in prevention of gastric aspiration, particularly during BVM ventilation
The maneuver is accomplished by applying gentle posterior pressure to the patient’s cricoid cartilage
This pressure causes the cricoid cartilage to be displaced posteriorly thus effectively closing off the esophagus.
Sellick’s Maneuver
Backward, upward, and rightward pressure on the larynx
The maneuver improves the visualization of the larynx structures and eases the intubation.
This procedure displaces the thyroid cartilage dorsally in such a way that the larynx is pressed against cervical vertebrae’s body, two centimeters in cephalic direction, until resistance appears.
Should be displaced 0.5 cm -2.0 cm to the right
BURP Maneuver
Most frequently used artificial airway device
Oropharyngeal Airway (OPA)
Soft rubber or latex uncuffed tube that is designed to conform to the patient’s natural nasopharyngeal curvature
It is designed to lift the posterior tongue off of the oropharynx
Nasopharyngeal Airway (NPA)
NPA
Which nostril is preferred as it is typically larger?
Right nare
Preferred supraglottic airway because it makes it simpler to use and avoids the need for cuff inflation and monitoring.
I-Gel (Supraglottic airway)
Indications for an I-Gel
An unconscious patient without significant direct trauma to airway/facial structures
I-Gel size for a typical adult
4
I-Gel size for an adult larger than 200 lbs
Size 5
ET Tube
Universally accepted size for an unknown victim
7.5 mm
ET Tube
Ventilate 1 breath every:
5 seconds
Also known as the double-lumen airway, is a blind insertion airway device (BIAD) often used in the pre-hospital, emergency setting
It is designed to facilitate the placement of an advanced airway in a patient in respiratory distress by providers with minimal training
Simplicity of placement is the main advantage over ET intubation
Esophageal Tracheal Combitube
Airway used when unable to perform endotracheal intubation and the casualty cannot be ventilated using a BVM device
Laryngeal Mask Airway
Optimal head position for insertion of the LMA
Sniffing Position
Supraglottic airway device with capabilities similar to those of the LMA to provide successful patient ventilation.
Not a definitive airway device and plans to provide a definitive airway are necessary.
Laryngeal Tube Airway (LTA)
Creation of a surgical opening in the cricothyroid membrane, which lies between the larynx (thyroid cartilage) and the cricoid cartilage.
Primary purpose is to provide an emergency breathing passage for a patient whose airway is closed by trauma, burns, closing of the airway, or unconsciousness
Surgical Cricothyrotomy
Two basic types of cricothyroidotomy
Needle
Surgical
Airway indicated for:
- Massive midface trauma precluding the use of BVM device.
- Inability to control the airway using less invasive maneuvers.
- Ongoing tracheobronchial hemorrhage.
Cricothyrotomy
A surgical cricothyroidotomy can be left in place for about ___ hours
24 hours
Position where the head is extended and neck is flexed
Sniffing position
ET Tube insertion should take no longer than:
30 seconds
Indications for Combitube
Patients who are trapped
Contraindications for cricothyroidotomy
- Any casualty who can be safely intubated, either orally or nasally.
- Casualties with laryngotracheal injuries
- Children under 10 years of age.
- **Casualties with acute laryngeal disease of traumatic or infections
- Insufficient training
