Airway management Flashcards
Describe anatomy of upper airway
signs: obstructed airway
paradoxical chest/abdo movements
cyanosis
stridor
curgling
accessory muscles
signs: partial v complete airway obstruction
LOOK: paradoxical chest/abdo movemenets and cyanosed v no movement
LISTEN: noisy breathing (stridor, snoring) v silent
FEEL: some air movement v no air movement
cause: collapsed airway in unconscious patient
loss of airwat muscle tone
causes: upper airway obstruction
- CNS depression
- foreign body aspiration
- infection (epiglottitis, tracheitis, croup etc)
- haemorrhage/haematoma
- trauma
- burns
- neoplasm
- congenital
- NMD
resus uk choking guideline
- mild with effective cough - encourage cough and check for deterioration to ineffective cough or obstruction relieved
- severe and conscious = 5 back blow and 5 abdominal thrusts
- sever and unconscious = start CPR
steps to open airway
- head tilt, chin lift
- jaw thrust
- nasopharyngeal airway if semi-unconscious
- oropharyngeal if unconscious
- supraglottic device/LMA
- ET tube
contraindications: oropharyngeal airway adj
conscious with gag reflex in tact
stimulates vomiting which can further obstruct airway
contraindications: nasopharyngeal airway adj
base of skull #
trauma to nose (eipstaxis etc)
measure oropharyngeal airway adj
inscisor teeth to angle of mandible
measure nasopharyngeal aiwary adj
tip of patient’s nose to earlobe
adv: LMA over ET
- quicker insertion
- easier insertion
- less CVS stimulation
- lower frequency of cough reflex on insertion
- lower incidence sore throat
- can be used outside of operating theatre - more user friendly
diadv: LMA over ET
- not secure - higher risk of aspirating
- gastric insufflation more likely
- can cause laryngospasm
- air leak
contraindications: LMA
non-fasted patient
severe GORD
morbidly obese
pregnancy
obstructive/abnormal lesions in oropharynx
increased airway resistance and decreased lung complicance
check: igel in correct position
- teeth resting on bite block (incisors)
- tip of igel in upper oesophageal opening
- cuff located against laryngeal framework in hypopharynx
placement of ET tubes anatomically
transverses airway via oropharynx or nasopharynx and passes through vocal cords to sit in trachea abovew carina
adv
placement of ET tubes anatomically
transverses airway via oropharynx or nasopharynx and passes through vocal cords to sit in trachea abovew carina
placement of ET tubes anatomically
transverses airway via oropharynx or nasopharynx and passes through vocal cords to sit in trachea above carina
adv
adv: ET tube
- transverses airway via oropharynx or nasopharynx and passes through vocal cords to sit in trachea abovew carinaprotects from aspiration
- provides access to tracheo-bronchial tree for suctioning secretions
- does not cause gastric distension and associated risk of regurgitation
- maintains patent airway and assists in avoiding further obstruction
adv
complications: ET tube
- oesophageal intubation
- endobronchial intubation (inserted past carina into one main bronchus so other lung not ventilated)
- impaction (ET tip against tracheal wall causes obstruction)
- herniation (cuff can cover distal end of tube if overinflated)
- stretching of tracheal wall (?necrosis)
- must be trained (anaesthetist) to place
signs: oesophageal ET intubation
- large air leak following cuff inflation
- no capnography after inflation breaths
- hypoxia
signs: endobronchial ET intubation
- hypoxia
- bronchospasm
- high airway inflation pressures
what permits air to flow in ET tube despite impaction
Murphy’s eye
def: Bougie
- long thin device used for routine or difficult intubation when laryngeal inlet not fully visualised
- can be used as introducer for ETT placement - tracheal clicks as introduced below vocal cords and then hold up - not hold up = ?oesophagus
def: Magill’s forceps
guide tracheal tubes through vocal cords or nasogastric tubes into oesophagus under direct vision
