Airway Management

Question 1

Airway Management

Answer 1

-Opening the airway

	-Head tilt/ chin lift - sniffing position

	-Jaw thrust- used in case of suspected or actual neck injury and spine injury

-Maintaining an open airway via accessory equipment

Question 2

-Pharyngeal airway

Answer 2

-restore airway patency

		-Aid in bag valve mask (BVM) ventilation

		-Provide access for suctioning

		-Separate tongue from posterior pharyngeal wall

		-Two types		

			-Oropharyngeal airway

			-Nasopharyngeal airway

Question 3

Oropharyngeal airway

Answer 3

-Many different sizes 40,60,70,80, and 100

-Two main styles, both with flange at end and a curved body

	-Guedel- single center channel

	-berman- two parallel side channels

-Sizing

	-Place device on side of Pts face with flange even with the corner of the Pts mouth

	-Correct size measures to th angle of the jaw following the natural curve of airway

-Contraindications in conscious or semiconscious pts, triggers gag reflex and can lead to vomiting and aspiration

Question 4

-Oropharyngeal airway

-Insertion- two techniques

Answer 4

-First displace tongue with tongue depressor. Insert airway by slipping over the tongue, following the curve of the oral cavity

	-Secondly use jaw lift technique to dos[lace the tongue. INsert airway with curve up. As the tip reaches the hard palate, the airways rotated 180 degrees aligning it with the pharynx

	-Correctly inserted- tip lies at based of tongue above epiglottis and flange outside of teeth

	-If not inserted correctly, may push tongue back and close off airway

-May be used as a bite block with an ET tube

Question 5

-Nasopharyngeal Airways

Answer 5

-Inserted through the nose into the mouth to the base of the tongue

-Indications

	-When placement of Oropharyngeal airway is not possible

	-More tolerated and used for semiconscious or conscious pts

	-Access for nasotracheal suctioning (especially repeated suctioning)

Question 6

-Nasopharyngeal Airways Size

Answer 6

-Made from rubber or plastic- flexible

-Sizes- by external diameter using French scale

	-26-32fr usual range for adults

	-length

		-More critical than diameter

		-measure from tip of Pts nose to the earlobe

Question 7

-Nasopharyngeal Airways

-Insertion

Answer 7

-Lubricate tip with water soluble lubricant

	-Tilt Pts head back

	-advance through either right or left naris

	-Bevel edge facing septum

	-If obstruction felt, gentle turning may clear

	-If continued resistance on insertion, may be deviated septum

		-Choose smaller airway

		-Use other nare

	-Once inserted stabilized by flange

	-Should be altered in nares at least every 24 hours

Question 8

-Nasopharyngeal Airways

-Hazards/ Complications

Answer 8

-Laryngospasm, coughing, nosebleeds, sinus infection from prolonged use

Question 9

Bag Mask Ventilation -Construction

Answer 9

-Contains a one way valve to keep exhaled gases from going into bag and re-delivered to pt

	-Can deliver around 100% oxygen with reservoir

Question 10

Bag Mask Ventilation -Positioning

Answer 10

-Best with RT at head of bed

	-Head tilt maneuver to open airway (Not with suspected neck injury)

Question 11

Bag Mask Ventilation

-Volume for adult

Answer 11

-6-6 ml/kg or 500-600 ml

	-Must have visible chest rise if not reposition head and check for obstruction/ foreign body

Question 12

Bag Mask Ventilation -Speed

Answer 12

-Speed

	-Deliver breath over 1 second


-During CPR

	-30:2 ratio allows 5 breaths per minute

	-After ET tube insertion, rate should be 8-10BPM

		-6-8 BPM permitted for COPD pts to reduce air trapping

		-Do not attempt to coordinate breaths with compressions

-After restoration of perfusing rhythm, use rate of 10-12 BPM delivered over 1 second

Question 13

Bag Mask Ventilation

-Manner of Use

Answer 13

-Use one hand to keep head tilted and mask firmly sealed on Pts face

		-C-E hold

		-Thumb and forefinger from E just under the edge of the jaw and lift up on jaw to seal against mask (assuming no neck injury)

	-Second hand is used to compress bag to deliver gas to PT

Question 14

Bag Mask Ventilation

-Hazards and troubleshooting

Answer 14

-Unrecognized equipment failure

	-Gastric inflation (leads to vomiting -possible aspiration)

		-When used with face mask

		-Minimized when using slower flows (1 second to deliver breath) and carful with the amt. Of volume delivered

	-Barotrauma potential if we use too large o volume for pt (ambu bag holds 1000 ml of volume)

	-Hyperventilation

		-Do not overzealously ventilate pt