Airway Flashcards by Vanessa Lopez

First step in assessing a patient

Airway management

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Upper airway consists of:

Nasal cavity

Pharynx

Larynx

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Lower Airway consists of:

Trachea, it’s branches, and the lungs

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Primary control centers come from the:

Medulla

Pons

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Primary involuntary respiratory center

Medulla

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Connected to the respiratory muscles by the vagus nerve

Pons

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Chemical stimuli - receptors for oxygen and carbon dioxide balance are located:

Carotid bodies (carotid sinus)

Aortic arch

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Primary control of respiratory center stimulation

Cerebrospinal (CSF) pH

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CSF is affected by the:

Amount of carbon dioxide in the body

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Form of respiratory drive in which the body uses oxygen

Hypoxic Drive

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Patients who are somewhat dependent on a hypoxic drive to breath normally only saturate at around ___% oxygenation

90-92%

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Factors that increase respiration

Body temperature

Emotion

Pain

Hypoxia

Acidosis

Stimulant drugs

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Factors that decrease respiration

Depressant drugs, Sleeping agents

Morphine

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When there is no oxygen available at all

Anoxia

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SaO2

Arterial oxygen saturation

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PaO2

Arterial oxygen tension

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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)

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Literally means “deficient in oxygen”, that is an abnormally low oxygen availability to the body or an individual tissue or organ

Hypoxia

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Insufficient oxygenation; that is decreased partial pressure of oxygen in blood

Hypoxemia

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Non-invasive method allowing the monitoring of the saturation of a patient’s hemoglobin

Pulse oximeter

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Pulse ox

Normal readings

95-100%

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Pulse ox

Values under ___ are considered low and a clinical emergency

90%

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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

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