AIRWAY ADJUNCTS Flashcards
indications for CPAP
Cardiogenic pulmonary oedema with moderate to severe respiratory distress, or
Asthma, COPD, or undifferentiated respiratory problem with severe respiratory distress that is not improving with treatment, or
An SpO2 of less than 92% due to a respiratory problem despite treatment (less than 88% if COPD or known chronic hypoxia).
contraindications of CPAP
Active vomiting, or
Ineffective breathing.
cautions of CPAP
An altered level of consciousness, or
Signs of shock, or
Clinical suspicion of pneumothorax.
flow rates of CPAP
Commence at 5 cmH2O.
Increase to 10 cmH2O if it is being tolerated.
Consider increasing to 15 cmH2O if the patient is not improving.
to ensure adequate seal of CPAP, before applying ensure….
The correct mask size is selected, and
Consideration of the contour of the face (especially the bridge of the nose and cheeks) and adjust the mask positioning as required, and
Dentures (if present) are kept in situ.
The reduction in cardiac output may be significant in patients with…
A clinical condition reducing right ventricular filling, such as hypovolaemia.
A clinical condition increasing right ventricular afterload, such as pulmonary embolism.
these patients may benefit from fluids to expand IV volume
in simple terms, outline the blood flow of the heart
- blood returns to the heart on the R side
- pushed through the lungs where gas exchange occurs
- Oxygenated blood returns to the LS of the heart where it is then distributed to the body via the aorta
outline the key pathologies that occur when CPAP is applied
- maintains positive end expiration pressure
- prevents collapse of the lung during expiration
- improve V/Q matching improving oxygenation
explain the patho of how fluid gets into the lungs in a patient with cariogenic pulmonary oedema
- L side of heart not functional, fluid backs up into the lungs due to pulmonary HTN + L side ineffective pump
- results in fluid crossing into the lungs due to shift in concentration gradient between the capillaries and airspace in the lungs
- R side of the heart has significantly more pressure to overcome to pump blood due to backup of fluid
how dose CPAP correct CPO
- reduces venous return on R side, less force to overcome to pump
- baroreceptors in heart detect increased intrathracic pressure -> further reduction in Q
- increased pressure in the airspace, evens out the concentration gradient between blood and air, this stops fluid leaking into lungs
how CPAP helps in COPD/asthma
-splints open airway obstructed by mucus plug
- maintains postive pressure preventing collapse of alvioli
- bronchodilators able to get down into airway
name some possible complications of CPAP
- not tolerated well
- air leaks
when is peep contradicted
in cardiac arrest for adults and children
why is peep not used in cardiac arrest for adults and children
PEEP is not applied to adults and children during CPR because an increase in intrathoracic pressure reduces the blood flow achieved during CPR. If ROSC is achieved it is appropriate to apply PEEP, but this is not an immediate priority.
adults indication for PEEP
if manual ventilation is being provided:
Apply PEEP at 5 cmH2O if the patient has traumatic brain injury (TBI), COPD, asthma or signs of shock.
Apply PEEP at 10 cmH2O for all other conditions.
For an adult with cardiogenic pulmonary oedema if CPAP is indicated but unavailable
children PEEP indcations
5cm for all conditions exept arrest if manual ventilation is being provided
admin of PEEP for CPO when CPAP is n/a
Apply PEEP at 10 cmH2O. Focus on ensuring a tight seal with the mask and do not assist the patient’s breathing unless it is ineffective.
Consider increasing PEEP to 15cmH2O if the patient is not improving.
Use PEEP with caution if the patient has signs of shock.
neonate PEEP indications
Apply PEEP to all pts requiring manual ventilation at 5 cmH2O, including during cardiac arrest
why is PEEP applied to neonates in arrest
PEEP is applied to neonates during CPR because the cause of cardiac arrest is usually respiratory failure and the balance of risk is in favor of improving ventilation, even though this may reduce blood flow achieved during CPR.
TBI and PEEP considerations
PEEP increases intracranial pressure in patients with TBI by reducing venous return from the brain. In this setting, there is a balance between the benefit of PEEP improving oxygenation and the risk of PEEP increasing intracranial pressure. This is why PEEP is set to 5 cmH2O for these patients.
how dose peep reduce the workload of breathing
The expiratory pressure assists small and medium sized airways to remain open during expiration, reducing lung collapse. Once collapsed, significant additional pressures are required to re-expand them.
The positive pressure in the thoracic cavity reduces the preload (filling) of the right ventricle by reducing venous return to the heart.
The positive pressure in the thoracic cavity increases the afterload of the right ventricle. This reduces blood flow through lung vessels, reducing the amount of fluid entering the lungs.
The expiratory pressure increases the amount of air remaining in the lungs at the end of expiration, (the functional residual capacity) and this causes the lungs to be more expanded. From this more expanded resting position, less work is required for inspiration because of the non-linear compliance of the lungs, particularly when the lungs are wet
what patients will be more susceptible to reduction in cardiac output from PEEP
A clinical condition reducing right ventricular filling, such as hypovolemia.
A clinical condition increasing right ventricular afterload, such as pulmonary embolism.
consider fluid to expand intravascular volume in theses patients.
indication for Magill forceps and laryngoscope
foreign body obstruction when patient is unconscious, and ventilation is inadequate + cannot be removed with finger sweep
usual size of laryngascope fopr adults
4
usual size laryngoscope for peads
2
if you cannot see the object with the laryngoscope what steps should be taken
-5 chest compressions to try and dislodge the object
- re-check airway
- commence CPR and attempt to ventilate with BVM
indication of OPA
patients requiring airway support unless clear reason not too
contra and cations of an OPA
conscious patients
patients with a gag reflex in tact
name some concerns/potential complications of an OPA
-gagging, vomiting and aspirating
- trauma to soft palate, tounge and pharynx
-
indications for oxygen administration
SP02 less then 92%
airway obstruction
other specific indication described within the CPGs:
TBI, shock, severe TBI, carbon monoxide poisoning, decompression sickness, condition requiring sedation, cluster headache
what can over oxygenation cause
- blood vessel vasoconstriction
- inflammation increases
considerations in a pediatric airway
- big occipital/ back of head (ramp head)
- big tounge
- weak Cartlidge rings/ more prone to closure
considerations when using laryngoscope on pediatrics
- in adults epiglottis closes when touched, kids don’t have that reflex, have to sweep it with the laryngoscope
- very sensitive to vagal response, airway interventions or touch to the neck can induce brady
what are the soft catheter suctions used for
down IGEL or tubes to suction
also good around mouth and nose
what is the de canto suction used for?
wide, good for very messy airway, getting down lower in the airway and vomit/chunks
consideration for suction in pediatrics
don’t want to use over 80 for suction strength
very susceptible to oral trauma and vagal response
