Airway Management

Question 1

patent airway

Answer 1

an airway (passage from nose or mouth to lungs) that is open and clear and will remain open and clear, without interference to the passage of
air into and out of the body.

Question 2

bronchoconstriction

BRON-ko-kun-STRIK-shun

Answer 2

the contraction of smooth muscle that lines the bronchial passages that results in a decreased internal diameter of the airway and increased
resistance to air flow.

Question 3

stridor (STRI-dor)

Answer 3

a high pitched sound generated from partially obstructed air flow in the upper airway.

Question 4

What are the steps is assessing an airway

Answer 4

• Is the airway open?
• Are they able to speak?
• Look
• Visually inspect the airway to ensure it is free from foreign bodies and obvious trauma
• Look for visual signs of breathing such as chest rise
• Listen
• Listen for the sound of breathing
• Listen for sounds of obstructed air movement such as stridor, snoring, gurgling, and gasping
• Feel
• Feel for air movement at the mouth
• Feel the chest for rise and fall
• Will the airway stay open?
• Are there immediate correctable threats?
• If no airway, then open it
• Consider how you might keep open an unstable airway
• Consider ALS for more definitive airway care
• Are there potential threats that may develop later?
• Reassess, reassess, reassess
• Assess for signs of impending collapse such as stridor or voice changes
• Consider conditions that may later threaten the airway (such as anaphylaxis)

Question 5

signs of an inadequate airway

Answer 5

■There are no signs of breathing or air movement.
■There is evidence of foreign bodies in the airway including blood, vomit, or objects like
broken teeth.
■There are no signs of breathing or air movement.
■There is evidence of foreign bodies in the airway including blood, vomit, or objects like
broken teeth.
■No air can be felt or heard at the nose or mouth, or the amount of air exchanged is below normal.
■The patient is unable to speak, or has difficulty speaking.
■The patient has an unusual hoarse or raspy quality to his voice.
■Chest movements are absent, minimal, or uneven.
■Movement associated with breathing is limited to the abdomen (abdominal
breathing).
■Breath sounds are diminished or absent.
■Noises such as wheezing, crowing, stridor, snoring, gurgling, or gasping are heard
during breathing.
■In children, there may be retractions (a pulling in of the muscles) above the clavicles
and between and below the ribs.
■Nasal flaring (widening of the nostrils of the nose with respirations) may be present,
especially in infants and children.

Question 6

cause of stridor

Answer 6

severely restrict air movement in the upper airway - partial obstruction

Question 7

cause of hoarseness

Answer 7

narrowing of the upper airway - partial obstruction - new onset is ominous

Question 8

cause of snoring

Answer 8

sound of the soft tissue of the upper airway creating impedance of the airflow - may indicate a change in mental status as muscle tone is diminished

Question 9

cause of gurgling

Answer 9

the sound of fluid obstructing the airway - sign that immediate suctioning is needed

Question 10

indications that spinal injury may have occurred

Answer 10

• mechanism of injury is one that can cause head neck of spine injury
• any injury at a of above the level of the shoulders indicates that head neck or spine injuries may also be present

Question 11

After the airway is opened (head tilt or jaw thrust) for a unresponsive patient what are the next steps you should take

Answer 11

After airway has been opened, position must be maintained to keep airway open

Airway must be cleared of secretions and other obstructions

Question 12

when opening the airway of a pediatric patient what do you need to keep in mind

Answer 12

• Infants and small children often have larger occipital regions of their heads
• Lying flat may cause hyperflexion of neck and airway occlusion
• Evaluate need to pad behind patient’s shoulders to achieve neutral airway position

Question 13

The two most common airway adducts are

Answer 13

Two most common airway adjuncts:
– Oropharyngeal airway (OPA)
– Nasopharyngeal airway (NPA)

Question 14

How do you measure the OPA

Answer 14

corner of the mouth to the tip of the earlobe

center of the mouth to the angle of the jaw bone

Question 15

What are the rules for using airway adjuncts

Answer 15

• Use OPA only on patients not exhibiting gag reflex
• Open patient’s airway manually before using adjunct device
• When inserting airway, take care not to push patient’s tongue into pharynx
• Have suction ready
• Do not continue inserting airway if patient gags
• Maintain head position after adjunct insertion
• Patient may regain consciousness
• Be prepared to remove adjunct and have suction ready
• Use infection control practices while maintaining airway

Question 16

What are the steps in inserting an OPA

Answer 16

• Open mouth with crossed-finger technique
• Position airway with tip pointing toward roof of mouth
1. Insert until you meet resistance
2. Gently rotate airway 180° so tip is pointing down into pharynx
3. Check that flange of airway is against lips
4. Monitor patient closely

Pediatric Note: Inserting OPA
• Use tongue depressor or rigid suction tip and insert OPA directly
• Do not rotate into place

Question 17

What are some of the benefits of the NPA

Answer 17

• Soft, flexible tube inserted through nostril
and into hypopharynx
• Moves tongue and soft tissue forward to provide a channel for air
• Can be used in patients with intact gag
reflex or clenched jaw
• Contraindicated if clear (cerebrospinal) fluid coming from nose or ears

Question 18

What are the steps for inserting a NPA

Answer 18

1. Lubricate outside of tube with water- based lubricant before insertion
2. Push tip of nose upward; keep head in
   neutral position
3. Insert into nostril; advance until flange rests firmly against nostril

Question 19

suctioning

Answer 19

use of a vacuum device to remove blood, vomitus, and other secretions of foreign materials away from the airway

Question 20

What is the required vacuum for suctioning

Answer 20

• Must furnish air intake of at least 30 Lpm at open end of collection tube
• Must generate vacuum of no less than 300 mmHg when collecting tube is clamped

Question 21

What are the components of a suction device

Answer 21

• Suction source
• Collection container
• Tubing
• Suction tips or catheters
and a container of clean or sterile water

Question 22

What is the name of the rigid tip suction device

Answer 22

• Also called “Yankauer Tip”

* Larger bore than flexible catheters

Question 23

What are the rules for using a rigid tip suction device

Answer 23

• Suction only as far as you can see
• Do not lose sight of distal end
• Careful insertion helps prevent gag reflex or vagal stimulation

Question 24

When do you use a flexible suction tip

Answer 24

• Designed to be used when a rigid tip
cannot be used
• Can be passed through a tube such as the nasopharyngeal or endotracheal tube
• Can be used for suctioning the nasopharynx

Question 25

What unit of measurement is used for a flexible suction tip

Answer 25

• Come in various sizes identified by a number “French” • Larger the number, larger the catheter

Question 26

Things to remember about a flexible suction device (words of caution)

Answer 26

• Not typically large enough to suction vomitus or thick secretions • May kink • In event of copious, thick secretions consider removing tip or catheter and using large bore, rigid suction tubing

Question 27

How do you measure a flexible suction device

Answer 27

* Measured in similar way as OPA * Length of catheter that should be inserted into patient’s mouth equals distance between corner of patient’s mouth and earlobe

Question 28

What infection control techniques are used while suctioning

Answer 28

• Protective eyewear, mask, disposable gloves

Question 29

List the suctioning techniques

Answer 29

• Suction no longer than 10 seconds at a time • Prolonged suctioning can cause hypoxia and bradycardia • If patient vomits for longer than 10 seconds, continue suction • Place tip or catheter where you want to begin suctioning • Suction on the way out

Question 30

Things to keep in mind for definitive airway care

Answer 30

• Keeping the airway open may exceed capabilities of a basic EMT • Medications and/or surgical procedures may be necessary to resolve airway obstruction • Rapidly evaluate and treat airway problems • Quickly recognize when more definitive care is necessary – May be advanced life support intercept – May be closest hospital

Question 31

what do you need to keep in mind when suction is required for a facial injury

Answer 31

* Frequently result in severe swelling or bleeding that may block or partially block airway * Bleeding may require frequent suctioning or more definitive airway

Question 32

When you are suctioning and encounter obstructions or larger particles what do you need to keep in mind

Answer 32

• Many suction units are not adequate for removing solid objects • Objects may have to be removed with manual techniques: abdominal thrusts, chest thrusts, finger sweeps

Question 33

While suctioning what do you do if the patient has a dental appliance

Answer 33

• Leave in place during airway procedures when possible • Partial dentures may become dislodged during an emergency • Be prepared to remove if airway endangered

Question 34

What do you need to keep in mind while suctioning a pediatric patient

Answer 34

* Smaller mouth and nose * Larger tongue * Narrow, flexible trachea * Open airway gently * Do not hyperextend neck * Consider adjuncts when other measures fail * Use rigid tip with adjunct, but do not touch back of airway

Question 35

What are the structures of the upper airway

Answer 35

``` • Begins at mouth and nose – Air is warmed and humidified in nasal turbinates • Pharynx – Oropharynx, nasopharynx, and laryngopharynx • Ends at glottic opening ```

Question 36

What are the structures of the lower airway

Answer 36

* Begins at glottic opening • Trachea * Bronchial passages * Alveoli

Question 37

There are a number of respiratory abnormalities that affect the body's ability to exchange oxygen for carbon dioxide. They include:

Answer 37

Upper airway foreign body obstruction Trauma to the upper airway Swelling of the upper airway from severe allergic reaction Severe tonsillitis Epiglottitis Lower airway obstruction from bronchospasm or COPD exacerbation Airway edema Impairment of chest wall movement from trauma Hemothorax Pneumothorax Neuromuscular disease, such as multiple sclerosis or muscular dystrophy Empyema, or pus in the pleural cavity Pleuritis, or inflammation of the pleural membranes Trauma to the phrenic or spinal nerves involved in breathing Stroke Central nervous system depressant overdose

Question 38

There are also a number of respiratory abnormalities that affect the body's ability to diffuse gases across membranes, which is an important process in cellular respiration. They include:

Answer 38

``` Low oxygen atmospheres Inhalation injury, such as inhalation of superheated gas Asbestosis Blebs from COPD Acute pulmonary edema Adult respiratory distress syndrome Pulmonary hypertension ```

Question 39

There are also a number of respiratory abnormalities that affect the body's ability to perfuse the tissues due to inadequate pumping of the blood from the heart. They include:

Answer 39

Hypovolemia Chest-wall trauma Pulmonary embolus Cardiac tamponade

Question 40

The findings that suggest an immediate life-threat in a patient with respiratory distress include the following:

Answer 40

``` Altered mental status Severe cyanosis Absent breath sounds Audible stridor Tachycardia Pallor and diaphoresis Use of accessory muscles of breathing and retractions Grunting ```