Airway/Breathing Flashcards
1
Q
Airway at risk
A
- an airway at risk assumes the rank of your highest clinical priority
- AIRWAY IS NOT BREATHING
- MCC airway obstruction is tongue and submandibular musculature relaxation/collapse
- our job is to:
- recognise an airway in trouble
- anticipate potential airway probs
- protect an airway that is or may be at risk
- act - temporize/manage an airway that is/may be at risk
2
Q
how to open an airway
A
- head tilt, chin lift
- use jaw-thrust alone if C-spine injury known, suspected, or possible
3
Q
Choking
A
- heimlich maneuver
- person should be conscious if you’re standing
- force and location of thrusts pushes air out to dislodge the foreign body
- unconscious? get help, call 911, defibrillator
- search for and remove an object you can see
- begin CPR, ACLS
4
Q
What does an airway in trouble look like?
A
- universal choking sign
- unconscious, deeply sedated
- respiratory distress, position preference
- getting sleepy while working to breathe
- changes in LOC - come in talking, now difficult to arouse
- sedated and vomiting
- head trauma, facial trauma
- infection somewhere along the airway
- burns - smoke inhalation
- face, tongue, neck edema
- severe bleeding from nose or mouth
- cyanosis, shock
5
Q
what does an airway in trouble sound like?
A
- Stridor: high-pitched insp or exp sounds, indicative of airway narrowing; insp at the glottis, exp below the glottis
- Gurgling
- Voice changes
- Drooling
6
Q
Airway options: suction
A
- rapidly clears secretions/blood, allows you to see, helps prevent aspiration
- a must during intubation, any advanced airway intervention or anytime there is a mess
- Yankauer suction tube, collection device, endotracheal tube thumb suction device
7
Q
Nasopharyngeal airway
A
- soft, pliable rubber tube with flange
- for SEMI CONSCIOUS pts with a gag reflex
- fits past tongue into posterior pharynx (bevel to septum, flange flush with nare)
- usually 3 sizes (measure tip of nose to tragus of ear)
- beware - may still vomit - need to keep an eye on them
8
Q
Oropharyngeal airway
A
- rigid, curved plastic tubes
- fit in pharynx behind tongue
- only for UNCONSCIOUS,, UNAROUSABLE pts = conscious or even semi-conscious will gag and vomit
- pre-intub ventilation helps to keep airway open
- post-intub - keeps patient from biting down on tube
- size: flange at corner of mouth to angle of jaw
- open mouth: cross-finger
- insert upside down, curve up, slide along roof of mouth
- rotate 180 degrees, over tongue
- Flange to lips
9
Q
Endotracheal intubation
A
- airway control in ED
- Direct laryngoscopy (DL) vs video lanyngoscopy
- secures airway by placing tube in the airway space
- requires you must now “breathe” for the pt - by hand or ventilator
10
Q
indications for ED intubation
A
- airway indications: cant protect/maintain their own airway d/t ALOC, airway patency threatened d/t edema, secretions, blood, infection, trauma
- breathing indications: failure to ventilate or oxygenate d/t pulmonary probs, cardiac probs, systemic probs, trauma, or preemptive d/t threat to airway patency (consciousness), oxygenation, ventilation, aspiration
11
Q
How to prepare for intubation
A
- O2 by nasal cannula - pre-oxygenate
- bag valve mask - BVM - essential skill - BVM: Not in conscious patient. High risk of vomiting if not paralyzed
- pre-intubation ventilation - 100% O2
- post-intubation first breaths (CO2 detector color change/listen to check tube placement, use while setting up ventilator)
- in between unsuccessful intubation attempts
-SOAP ME checklist - check before you start: Suction, O2, Airway equipment, Pharmacy, Monitoring Equipment
12
Q
Intubation
A
- have plan A, B, and C
- RSI - rapid sequence intubation - pt is paralyzed to gain control; intubation easier, deals with full stomach, prevents aspiration
- The 7 Ps:
- Possibility of success
- prepare
- pre-oxygenation
- pre-treatment
- induction/paralysis
- positioning/protection
- pass it, prove it, post procedure tasks
13
Q
Rapid sequence intubation
A
- Beware of paralyzing a patient!
- Paralyzed patient = no respiratory effort
- You MUST be able to adequately ventilate the patient with bag-valve-mask
- Must anticipate a successful intubation or do not paralyze
- Beware of esophageal intubation
- No color change, low pulse ox, no breath sounds.
- CXR is not reliable to determine if tube is in esophagus – CXR for depth of tube only
14
Q
Adjuncts and alternatives to intubation
A
-Bougie - tube over the wire
- LMA - Laryngeal Mask Airway, King Tube
- Supraglottic airway devices
- Designed for blind insertion - goal is esophagus, not trachea
- LMA for minor surgery common, good Plan B
- LMA, King tube common in EMS
-Nasotracheal intubation and/or fiber optic guided
- All designed to minimize risk of the failed airway
- Cannot intubate but can oxygenate – temporary, not secure
- Cannot intubate, cannot oxygenate – worst case scenario
15
Q
Surgical airway
A
- Cricothyrotomy
- Alternative method of airway control when intubation fails or is not possible
- Bypasses the traditional upper airway
- Plan B or C for failed intubation
- Tracheotomy – placed in OR
- For pt’s needing prolonged airway support
