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Medical Emergencies > Airway Management > Flashcards

Airway Management Flashcards

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USMLE® Step 1 flashcards
1
Q

Overview

A

-applies knowledge of general anatomy and physiology to patient assessment and management in order to assure a patent airway, adequate mechanical ventilation, and respiration for patients of all ages

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2
Q

respiratory system function

A
  • oxygen delivery to tissue, carbon dioxide removal from tissue
  • any interruption in this process impairs organ function
  • brain tissue begins to die within 4 to 6 minutes
  • important to detect airway problems quickly and intervene properly and rapidly
  • requires constant reassessment
  • must be able to locate parts of the respiratory system and understand how the system works
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3
Q

two primary functions of respiratory system anatomy

A
  • two primary functions:
    1. ventilation- moving air in and out of lungs
    1. respiration- gas exchange
  • > upper airway- structures above vocal cords (nose, mouth, jaw, oral cavity, and pharynx)
  • > lower airway- trachea to alveoli
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4
Q

upper airway anatomy

A
  • main functions:
  • warm
  • moisten
  • filter air
  • nasal cavity:
  • conchae and meatuses increase turbulence
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5
Q

the pharynx

A
  • three regions:
    1. nasopharynx- air passage with pharyngeal tonsil
    1. oropharynx- common rout for food and air
    1. laryngopharynx - extends to the larynx
  • differing types of epithelial tissue here
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6
Q

anatomy of the upper airway: nasopharynx

A
  • formed by the union of facial bones

- warms and humidifies air as it enters the body

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7
Q

the larynx

A
  • keeps food and drink out of airway
  • marks where the upper airway ends and the lower airway begins
  • extrinsic muscles connect larynx and elevate it during swallowing
  • intrinsic muscles control vocal cords
  • epiglottis
  • cartilage
  • hypoid bone
  • ligaments
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8
Q

lower airway anatomy

A
  • function- conduct air to gas exchange surfaces
  • trachea, bronchi, and lungs
  • trachea and bronchi supported by cartilage
  • smooth muscle is walls of bronchial tree allow for dilation and constriction
  • smallest bronchioles connect to alveoli
  • oxygen transported back to heart, distributed to rest of body
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9
Q

musculoskeletal system support of respiration

A
  • main muscle of ventilation: diaphragm
  • innervation- phrenic nerve (C3, C4, C5)
  • changes in size/volume of thoracic cavity drive inspiration (active) and expiration (passive)
  • accessory muscles: intercostals, abdominals, and pectorals
  • if patient is using accessory muscle to breathe, list “respiratory compromise” or “impending respiratory failure” in DD
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10
Q

ventilation

A
  • regulation of ventilation is primarily by the pH of the cerebrospinal fluid
  • directly related to the amount of carbon dioxide in the plasma
  • failure to meet the bodys need for oxygen may result in hypoxia
  • patients with COPD have difficulty eliminating carbon dioxide through exhalation
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11
Q

respiratory system physiology

A
  • blood flows back to the heart (right side) -> lungs -> heart (left side) -> entire body
  • main function of respiratory system: exchange gases at alveocapillary membrane
  • regulated by nerves, sensors, and hormones
  • CO2 level in body is the prime modulator of respiration
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12
Q

respiration: chemical control

A
  • chemical control of breathing:
  • respiratory center in brainstem has sensors for CO2 levels in blood and CSF
  • when CO2 levels increase, pH decrease -> medulla signals phrenic nerve to move diaphragm
  • chemoreceptors monitor blood/body fluid for change in H+, CO2 and O2
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13
Q

eventually all cells will die if deprived of oxygen

A
  • time is critical
  • 0-1 min -> cardiac irritability
  • 0-4 min -> brain damage not likely
  • 4-6 min -> brain damage possible
  • 6-10 min -> brain damage very likely
  • more than 10 minutes -> irreversible brain damage
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14
Q

patient assessment

A
  • recognizing abnormal breathing
  • unequal or inadequate chest expansion
  • increased effort of breathing
  • shallow depth
  • skin that is pale, cyanotic, cool or moist
  • skin pulling in around ribs or above clavicles during inspiration
  • 12-20 respiration rate?
  • patients with inadequate breathing need to be treated immediately
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15
Q

intercostal retractions

A
  • ribs come out under the soft tissue

- become viable while breathing

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16
Q

sternum retractions

A

-sternum becomes visible while breathing moving up and down

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17
Q

know lung sounds and where

A
  • wheezing (bronchoconstriction)
  • rails (crackles) - pneumonia -> fluid
  • ronchi
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18
Q

stridor

A

-lung sound in upper airway

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19
Q

oxygen saturation

A
  • lower than 90 respiratory failure

- 90-94 respiratory distress

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20
Q

COPD

A

-chronic obstructive pulmonary disease
-emphysema and chronic bronchitis
-trouble releasing CO2
-

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21
Q

tidal volume

A
  • amount inhaled or exhaled in one breath under resting conditions
  • giving someone too much tidal volume on a ventilator can cause pneumothorax
  • 500ml is average
  • 5-6cc per kilo = tidal volume
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22
Q

agonal respirations*

A

a patient may appear to be breathing after the heart has stopped

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23
Q

cheyne stokes respirations*

A
  • cheyne-stokes respirations are often seen in stroke and head injury patients
  • breathing normal for a minute (ex. 20/mins) then breathing drops (ex. 6/mins)
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24
Q

ataxic/biots respirations

A
  • irregular or unidentifiable pattern

- may follow serious head injuries

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25
Q

Kussmals respirations

A
  • deep and fast gasping respirations
  • lacking any apneic periods
  • associated with metabolic/toxic disorders (diabetes mellitus)
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26
Q

assessment of respiration

A
  • skin color and level of consciousness are excellent indicators of respiration
  • also consider oxygenation
  • pulse oximetry is the initial method to assess oxygenation status
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27
Q

health tilt-chin lift maneuver

A
  • maneuver will open the airway in most patients
  • for patients who have not sustained or are not suspected of having sustained trauma (you can cause major damage if they do)
    1. with patient supine, position yourself beside patients head
    1. place heel of one hand on forehead, apply firm backward pressure with palm
    1. place fingertips of other hand under lower jaw
    1. lift chin upward, with entire lower jaw
28
Q

jaw-thrust maneuver

A
  • use if you suspect a cervical spine injury
    1. kneel above the patients head
    1. place your fingers behind the angles of the lower jaw
    1. move the jaw upward
    1. use your thumb to help position the jaw
29
Q

initial observations

A
  • awake and alert -> may be respiratory distress -> can go into respiratory failure
  • respiratory distress vs respiratory failure
  • distress- patient will improve with simple resuscitation methods (positioning, oxygen administration by simple face masks)
  • if not or if pt has signs of fatigue or altered mental status, respiratory failure is imminent
  • if color is changing -> may be respiratory failure
  • look at eyes, cap refill -> failure
30
Q

signs of respiratory failure

A

impending respiratory failure

  • respiratory rate greater than 30 or greater less then 6 breaths/min
  • oxygen saturation less then 90%
  • use of multiple accessory muscle groups
  • inability to lie supine
  • tachycardia with a rate greater than 140 beats/min (heart is beating faster to compensate for low oxygen)
  • mental status change
  • inability to clear oral secretion/mucous
  • cyanosis of nail beds or lips
31
Q

first thing to do if someone is having trouble breathing

A

-sit them up!

32
Q

things to look for

A
  • circulation/perfusion:
  • skin color is fastest way to get initial impression of patients circulation
  • generalized cyanosis: oxygen desaturation
  • pallor- shock
  • assess mucous membranes for more subtle info (inside mouth, under eyelids), color moisture
  • skin assessment not as valuable in older patient
33
Q

first impression: initial presentation

A
  • asses for LOC and work of breathing and do aquick check of perfusion status
  • look for clues in field assessment and confirm by thorough assessment
  • have you been intubated before? (tube down trachea)
  • tripod positioning?
  • pursed lip breathing?
34
Q

key findings in patients with dyspnea

A
  • duration:
  • chronic- usually related to cardiac disease, asthma, COPD, or neuromuscular disease
  • acute- asthma exacerbation, infection, pulmonary embolus, acute cardiac dysfunction, inhalation toxic substance, allergen, foreign body
  • onset:
  • sudden- pulmonary embolism, spontaneous, pneumothorax
  • slow- pneumonia, CHF, malignancy
35
Q

detailed assessment

A
  • vital signs- baseline vital signs: temp, pulse, respiration, BP, O2 saturation, end-tidal CO2
  • repeat periodically depending on condition
  • monitor how respiration and perfusion are affecting pts mental status
  • primary survey determined vital functions and life threats
  • now determine respiratory rate
  • Pt breathing without difficulty, but at a high rate (tachypnea): shock: metabolic acidosis triggers increase in RR. Bradypnea with no accessory muscle use: may be CNS problem or drug use.
  • history taking- ask patient to relate current symptoms to those of previous episodes
36
Q

tension pneumothorax

A 
-air hunger
r-respiratory distress
-pressure increases
-hypotensive- putting pressure on something that normally doesnt
-tachycardia
-respiratory distress
-tracheal deviation- (opposite side of injury)
-unilateral absence of breath sounds
-jugular vein distention (JVD)
-cyanosis (late)
-treatment:
-needle decompression to relive pressure
-incision to decrease pressure
-thoracotomy is the treatment*
-chest x-ray is the diagnostic tool*
-
37
Q

physical exam

A
  • by now LOC and degree of stress should be known
  • proceed with focused PE noting relevance to dyspnea
    1. neurologic exam- brain is intolerant to long periods without blood, O2 and glucose
  • keep re-evaluating mental status in pts with dyspnea (person, place, time, verbal coherence, response time
    1. neck exam- look for JVD when pt is sitting upright (common with COPD, asthma, cardiac failure, cardiac tamponade, pneumothorax)
  • JVD in otherwise healthy, young person lying flat (but not while sitting) would be normal
38
Q

tracheal deviation

A

-late sign of tension pneumothorax

39
Q

thoracotomy

A

-incision and insertion of tube to relive pressure and inflate lung

40
Q

basic airway adjuncts

A
  • prevents obstruction by the tongue and allows for passage of air and O2 to the lungs
  • stick it into the mouth and have it sit at the teeth
  • prevents closing of mouth so you can ventilate the patient
  • if they are awake and/or have a gag reflex -> dont use this (they can vomit/aspirate)
  • use on unconscious patients without gag reflex
41
Q

basic airway adjuncts: oropharyngeal airways

A
  • OPA
  • keep tongue from blocking upper airway
  • easier to suction oropharynx if necessary
  • indications:
  • unresponsive patients without a gag reflex
  • apneic patients being ventilated with a bag mask device
  • contraindications includes:
  • conscious patients
  • any patient who has an intact gag reflex
42
Q

basic airway adjuncts: nasopharyngeal airways

A
  • NPA*
  • used with a patient who:
  • is unresponsive or has an altered LOC
  • has intact gag reflex
  • is unable to maintain his or her own airway spontaneously
  • indications:
  • semiconscious or unconscious patients with an intact gag reflex
  • patients who will not tolerate an oropharyngeal airway
  • contraindications:
  • suspected head injury of any kind
  • history of fractured nasal bone
  • dont use on people with head trauma
43
Q

suctioning

A
  • you must keep the airway clear to ventilate properly
  • portable, hand operated and fixed equipment is essential for resuscitation
  • any patient having difficulty breathing can use this
  • stick a rigid tube in the mouth and suction out any blood, vomit, secretions that may be in the mouth
  • decreases risk of aspiration pneumonia
44
Q

supplemental oxygen

A
  • always give to patients who are hypoxic
  • some tissues and organs need constant supply of O2
  • never withhold oxygen from any patient who might benefit from it
  • supplemental oxygen equipment
  • become familiar with how oxygen is stored
  • oxygen cylinders contain compressed gas
  • liquid oxygen is becoming a more commonly used alternative
45
Q

oxygen delivery equipment

A
  • nonbreathing masks
  • bag mask devices- BVM
  • nasal cannulas- goes into nose
  • use a nasal cannulas for minor distress
  • use a BVM for manual ventilations (pt cant do it themselves) -> going through failure phase
  • nonbreathing masks for moderate respiratory distress
46
Q

nonrebreathing masks

A
  • preferred way to give oxygen in the prehospital setting
  • to patients who are breathing adequately but are suspected of having hypoxia
  • combination mask and reservoir bag system
  • use for moderate respiratory distress patients
  • Make sure the reservoir bag is full before placing the mask on the patient
  • Adjust the flow rate so the bag does not collapse when the patient inhales
  • Usually 10 to 15 L/min*******
  • Moderate respiratory distress
  • When oxygen therapy is discontinued, remove the mask
  • Delivers oxygenation at 60-95%
47
Q

nasal cannulas

A
  • delivers oxygen through two small, tube-like prongs that fit into the nostrils
  • can provide 24% to 44% inspired oxygen when the flowmeter is set a 1 to 6 L/min*******
  • when you anticipate sustained long term therapy, consider using humidification as you can have a burning sensation to the nares
  • humidification helps to keep tissues moistened
  • when is it appropriate for use?
  • maintenance of O2 levels for chronic illnesses (COPD, emphysema, bronchitis)
  • in mild respiratory distress and will help to calm patient with minimal oxygen levels
  • used on people with minor distress (maybe chronic issues)
48
Q

assisted and artificial ventilation

A
  • probably the most important skill in at any level
  • basic airway and ventilation techniques are extremely effective
  • assisting ventilation in respiratory distress/failure
  • intervene quickly to prevent further deterioration
  • 2 treatment options- assisted ventilation and CPAP
49
Q

artificial ventilation

A
  • patients in respiratory arrest need immediate treatment to live
  • forcing air through bag mask maybe
50
Q

signs and symptoms of inadequate ventilation

A
  • altered mental status
  • inadequate minute volume
  • excessive accessory muscle use and fatigue
  • head bobbing, sleepiness
51
Q

normal ventilation versus positive-pressure ventilation

A
  • in normal breathing, the diaphragm contracts and negative pressure is generated in the chest cavity
  • positive pressure ventilation generated by a device (such as bag mask device) forces air into the chest cavity
  • with positive pressure ventilation- (forcing air into the chest)
52
Q

positive pressure ventilation

A
  • forcing air into the chest
  • must be careful about how much youre pumping (pneumothorax)
  • increased intra thoracic pressure reduces the blood pumped by the heart
  • more volume is required to have the same effects as normal breathing
  • air is forced into the stomach, causing gastric distention
  • You know that you are providing adequate ventilations if:
  • Patient’s color improves
  • Chest rises adequately
  • You do not meet resistance when ventilating
  • You hear and feel air escape as the patient exhales
53
Q

bag mask device

A
  • Most common method used to ventilate patients in EMS and during initial respiratory failure in the ER
  • Provides less tidal volume than mouth-to-mask ventilation
  • If you have difficulty adequately ventilating a patient, switch to another method
  • Volume of oxygen delivered is based on chest rise and fall
  • Work together with your team to provide ventilation
  • Oxygen administer at 10-15 L/min***
  • Severe respiratory distress***
  • 75-100%
54
Q

continuous positive airway pressure (CPAP)

A
  • noninvasive ventilatory support for respiratory distress
  • many people diagnosed with obstructive sleep apnea wear a CPAP unit at night
  • forcing air into the lung cavity
  • congestive heart failure, CHS, COPD
  • becoming widely used at all levels of healthcare
  • provides continuous positive airway pressure (same as BMV but it is automatic)
  • allows for proper gas exchange
55
Q

CPAP mechanism

A
  • Increases pressure in the lungs
  • Opens collapsed alveoli
  • Pushes more oxygen across the alveolar membrane
  • Forces interstitial fluid back into the pulmonary circulation
  • Therapy is delivered through a face mask held to the head with a strapping system
  • Use caution with patients with potentially low BP
  • increases intrathoracic pressure -> aspiration
56
Q

CPAP indications

A
  • Patient is alert and able to follow commands.
  • Patient displays obvious signs of moderate to severe respiratory distress.
  • Patient is breathing rapidly.
  • Pulse oximetry reading is less than 90%.
  • patients needs to be breathing with the machine!
  • alert, good mental status
57
Q

CPAP complications

A
  • Some patients may find CPAP claustrophobic
  • Possibility of causing a pneumothorax
  • Can lower a patient’s blood pressure
  • If the patient shows signs of deterioration, remove CPAP and begin positive-pressure ventilation using a bag-mask device
58
Q

CPAP contraindications

A
  • Patient in respiratory arrest or unconscious
  • Signs and symptoms of pneumothorax or chest trauma (if you add pressure on top of the already high pressure it can be bad!)
  • Patient who has a tracheostomy
  • Active gastrointestinal bleeding or vomiting
  • Patient is unable to follow verbal commands
59
Q

gastric distention

A
  • occurs when artificial ventilation fills the stomach with air
  • most commonly affects children
  • most likely to occur when you ventilate the patient too forcefully or too rapidly
  • may also occur when the airway is obstructed
60
Q

foreign body airway obstruction

A
  • If a foreign body completely blocks the airway, it is a true emergency.
  • early recognition is crucial
  • Will result in death if not treated immediately
  • in an adult, it usually occurs during a meal
  • In a child, it can occur while eating, playing with small toys, or crawling
  • tongue is the most common airway obstruction
  • causes of airway obstruction that do not involve foreign bodies include:
  • swelling, from infection or acute allergic reaction
  • trauma (tissue damage from injury)
61
Q

mild airway obstruction

A
  • patients can still exchange air, but will have respiratory distress
  • noisy breathing, wheezing, coughing
  • with good air exchange, do not interfere with the patients efforts to expel the object on his or her own
  • with poor air exchange, the patient may have increased difficulty breathing, stridor, and cyanosis
  • treat immediately
62
Q

severe airway obstruction

A
  • patients cannot breathe, talk, or cough
  • patient may use the universal distress signal, begin to turn cyanotic, and have extreme difficulty breathing
  • provide immediate treatment to the conscious patient
  • if not treated, the patient will become unconscious and die
  • any person found unconscious must be managed as if he or she has a compromised airway
63
Q

emergency medical care for foreign body airway obstruction

A
  • perform a head tilt-chin lift maneuver to clear a tongue obstruction
  • look for object
  • abdominal thrusts are the most effective methods of dislodging and forcing out an object
  • after you have tried everything (bag mask, nonbreathing, tube) -> if unable to open airway must consider needle/surgical cricothyrotomy at level of the cricothyroid membrane
64
Q

needle/surgical cricothyrotomy

A
  • cricothyroid membrane incision to access the trachea
  • insert a tube to provide positive pressure ventilation
  • directly to the source
  • bypasses
65
Q

summary

A
  • What differentiates the upper airway from the lower airway?
  • What is the function of the various structures located within each?
  • What is the primary regulator of respiration?
  • What does the process of gas exchange entail?
  • What are the various respiratory patterns?
  • What is the disease process that corresponds to each?
  • What clinical findings allow you to differentiate the various respiratory patterns?
  • Oxygen Administration Equipment:
  • What are the various flow rates associated with the devices?
  • Patient presentation will dictate what oxygen administration tool is most appropriate.
  • CPAP:
  • How is it effectively used?
  • What are the various contraindications?

Medical Emergencies (16 decks)

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