Airway and C-spine Flashcards
What structures in the oral cavity can play a role in airway obstruction?
- Teeth
- Gums
- Tongue - most important
- Soft palate
- Hard palate
Wht is the unconscious patient at risk of airway obstruction?
Previously thought to be posterior displacement of the tongue, but more recently shown to be a complex mechanism involving the tongue and epiglottis as the source of airway obstruction.
Key message - patency is controlled by soft structures which, when innervated, provide good tone. The absence of muscular stimulation allows a change in structure leading to obstruction of airway
What is the easiest way to assess someone’s airway?
Talk to them
If a patient is talking without any difficulty, what does this indicate about the patency of their airway?
No major obstruction at that point in time
What is meant by the term “open airway”?
You can see it is open
What is meant by the term “patent airway”?
Clinical signs of air passing in and out of the airway
What is meant by the term “maintained aiway”?
Upper airway reflexes are intact including the cough and gag reflex - “the patient is maintaining their own airway”
What is meant by the term “threatened airway”?
Clinical suspicion is that there may be imminent deterioration in airway patency
How would you assess someones airway?
Look, Listen, feel
- Look for obvious ventilation
- Look at airway - injuries, swelling, detritus, blocking*
- Look in the airway*
- Listen for signs of airway obstruction - partial/complete
- Feel for breath - feel chest rising, feel for breath on cheek
*Consider quick consciousness assesment - full sentences/phrases/single words/at all
https://www.youtube.com/watch?v=4xAM69MitzQ - Video time 1.15 -> 3.57
What are signs of airway obstruction?
- Absent breath sounds
- Added sounds of laboured breathing
- Paradoxical chest movements
- Use of accessory muscles
- Reduced consciousness
What added sounds might you hear in somoene with laboured breathing?
- Stridor
- Expiratory wheeze
- Gurgling
- Stertor
What is stridor?
Harsh, high-pitched sound heard in upper airway obstruction caused by turbulent airflow at the supraglottis, glottis, subglottis or trachea
If someone was making the following noise on breathing, what might it indicate?
Stridor - Significant airway obstruction
What can the following indicate in someone with laboured breathing?
Expiratory wheeze - lower airway obstruction
What might gurgling be a sign in a patient struggling to breath?
Fluids in the lung - blood, vomit
Why do paradoxical chest movements occur in someone with an airway obstruction?
With airway obstruction, air is unable to enter the thoracic cavity, meaning the negative pressure caused by the diaphragm causes the chest to be drawn inwards - This appears as abdominal expansion and chest sucking inwards - “see saw” movement
What does paradoxical chest movements indicate?
Complete airway obstruction
What does use of accessory muscles indicate?
Increased respiratory effort required due to obstruction
What are features of partial airway obstruction?
- Use of accessory muscles
- Tracheal tug
- Paradoxical chest movements (almost complete obstruction)
- Intercostal recession
- Tripoding stance
What are features of complete airway obstruction?
- Absent breath sounds
- Unable to talk
- Silent chest
- Paradoxical chest movement
What are common causes of airway obstruction in a pre-hospital setting?
- Loss of consciousness
- Foreign Body
- Trauma
- Aspiration - Blood, Saliva, Vomit
- Airway interventions
- Inhalational injury (Burns)
- Anaphylaxis
If you found someone who was sterterous, what airway intervention would you start with?
If C-spine is clear:
- Head tilt and chin lift
https://www.youtube.com/watch?v=4xAM69MitzQ - Video time 4.26 -> 5.17
What would you want to establish in someone before performing any airway maneuvre’s?
If they had a C-spine injury
If someone was sterterous and you suspected a C-spine injury, what intervention would you consider using first?
Jaw-thrust
https://www.youtube.com/watch?v=4xAM69MitzQ - Video time 4.28 -> 5.17
How does the head tilt-chin lift manoeuvre work?
Anterior displacement of the hyoid bone is key in restoring airway patency, and that this is achieved by a head tilt-chin lift.
When would you consider suction to manage someone’s airway?
- Audible secretions such as gugrling
- Noisy Crackles
- Ineffective cough with a physiological deterioration in a patient
https://www.youtube.com/watch?v=4xAM69MitzQ - Video Time - 5.20 -> 5.55
How might you position a patient to aid with suctioning?
On their side (if possible) as gravity aids drainage
How long should you suction for?
15 seconds maximum - any longer is associated with risk of hypoxia
What could you use to remove obstructions in the airway which are within view?
Magill forceps - used to remove foreign bodies and aid delivery of ET tube
https://www.youtube.com/watch?v=4xAM69MitzQ - Video time 5.39 -> 5.55
If an initial head-tilt, chin lift/jaw thrust failed to maintain a good airway, what would be your next step in establishing a good airway?
- Oropharyngeal airway
- Nasopharyngeal airway
What is the function of an oropharyngeal airway?
Inserted to prevent the tongue from covering the epiglottis maintaing the patency of the airway
How would you size an oropharyngeal airway?
Measure with the flange at the front teeth and the tip should reach the angle of the mandible