Airway Flashcards
Who do you contact for an emergency trachea?
ENT
What are the different airway management techniques?
Chin lift
Jaw thrust
Oropharyngeal airway
Nasopharyngeal airway
Extra glottic and supraglittic devices
Endotracheal intubation
What are the clinical signs of an obstructed airway?
Agitation or obtuned or abusive (think hypoxia)
Retractions and use of accessory muscles
Abnormal sounds
Deviated trachea
What are the clinical signs of a fracture to the larynx?
Hoarseness, subcutaneous emphysema and palpable fracture
If a patient has a sever airway obstruction what might they require?
An emergency surgical airway - make sure that the difficult airway equipment is available
How might patient with neck trauma present?
They may initially be able to maintain the patency of their own airway but are at high risk of developing obstruction: plan for early intubation!
What does trauma to the face require?
Aggressive and careful management of the airway
What can penetrating injury to the neck cause?
Vascular injury with associated expanding haematoma which can result in displacement and obstruction of the airway
Why should you be aware of a patient with facial fractures refusing to lie flat?
They may lack the ability to manage their own secretions
What can fractures and dislocations to the mid face cause?
Compromise to the nasopharynx and oropharynx due to associated haemorrhage, increased secretions and dislodged teeth
What is the best way to assess an airway?
Look - for any obvious obstruction
Listen - noisy?quiet?silent?
Feel - air coming in and out
If you hear an inspiratory strider, what would you suspect?
Obstruction at the laryngeal level or above
If you hear an expiratory strider, what would you suspect?
Obstruction of the lower airways, which tend to collapse and obstruct during expiration
If you hear gurgling, what would you suspect?
Presence of liquid or semisolid foreign material in the upper airways
If you hear snoring, what would you suspect?
The pharynx is partially occluded by the tongue or palate
If you hear a silent airway, what would you suspect?
Complete obstruction
When should a surgical airway be considered?
When an obstruction of the airway means that an ETT cannot be placed down the trachea to provide adequate oxygenation
What is the preferred surgical airway?
Surgical cricothyroidotomy
What does a needle cricothyroidotomy involve?
The insertion of a needle through the cricothyroid membrane into the trachea below the level of the obstruction to provide temporary, supplemental oxygenation on a short term basis until a definitive airway can be placed. Connect to oxygen at 15 L/min with a Y connector or a side hole in some 02 tubing with intermittent insufflation. Can adequately oxygenate for 30-45 mins
With the jet insufflation technique, what large-calibre cannula should be used in adults and children?
12-14 gauge for adults and
16-18 gauge for children
How is a surgical cricothyroidotomy performed?
Place patient in supine position
Making an incision that extends through the cricothyroid membrane. A bougie is then inserted into the trachea and a small ETT over the bougie
Ventilate lungs with self inflating bag attached to high flow
Confirm with auscultation and capnography
Is a surgical cricothyroidotomy
recommended in children under the age of 12 years old?
No
Why is a tracheostomy contraindicated in an emergency?
Time consuming
Hazardous
Requires considerable surgical skill and equipment
Substantial bleeding can occur
How do you do a chin lift?
Place one hand on patients forehead and tilt the head back gently
Place the fingertips of the other hand under the point of the patients chin and gently lift
When would you do a jaw thrust?
Suspected spinal injuries
How do you do a jaw thrust?
Identify the angle of the mandible, and then apply steady upward and forward pressure to lift the mandible
Using the thumbs, slightly open the mouth by downward displacement of the chin
How do you size a guedel airway?
Measure from the patients incisors to the angle of the jaw
How do you insert a guedel airway?
Open patients mouth and ensure no foreign material that can be pushed down
Insert in the upside down position as far as the junction between the soft and hard palate then rotate 180 degrees
Advance airway until it lies within the pharynx
When would you not use a NP airway?
Patient has suspected base of skull fracture
How do you insert a NP airway?
Insert bevel end first, vertically along the floor of the nose with a slight twisting action
The curve of the airway should direct it towards the patients feet
What are epistats and mouth props used for?
Facial trauma
What is the preferable emergency airway for children under 12 years old?
Needle cricothyroidotomy
What equipment is needed for a needle cricothyroidotomy?
Wide bore non kinking cannula
High pressure oxygen source
How does heliox work?
It has low density which acts by lowering the resistance to gas flow within the airways and permitting an increase in ventilation
Where do you find Heliox in the department?
Contact the porters who will get it
What conditions can be treated with Heliox?
Upper airway obstruction croup
Post extinction strider asthma
COPD
What suspected injury would we use mouth props for?
Lafort fracture (facial fracture affecting bridge of nose and face)
