Airway Management Flashcards
Three manoeuvres for opening airway?
Head tilt
Chin lift
Jaw thrush
Nasal cannula - rate of flow and max O2 conc?
1-6 L/min
Max 40% oxygen
Simple (Hudson) face mask - rate of flow and max O2 conc?
5-10 L/min
What is venturi mask? rate of flow? oxygen concentration and colours?
Allows controlled amount of oxygen to be delivered
- V24: 2-4L/min blue
- V28: 4-6L/min white
- V35: 8-10L/min yellow
- V40: 10-12L/min red
- V60: 12-15L/min green
- V … = % of oxygen delivered
Non-rebreathe mask - rate of flow and oxygen concentration?
- 15L high flow oxygen
- Critically unwell patients
- 80% oxygen
When should a bag valve mask be used?
When patients respiratory effort not sufficient to ventilate
How is an oropharyngeal airway guedel measured and inserted?
- Measure from between incisors to angle of jaw
* Insert backwards then rotate 180 degrees
How is nasopharyngeal airway sized? When not to use it?
- Sized according to internal diameter in millimetres (size of patients little finger)
Don’t use in evidence of basal skull fracture
Requirements of non-invasive support? How does it work?
- Requires the patient to be alert and cooperative, they must be able to cough, make their own respiratory effort and protect their airway
- Assists the patient’s own breathing, reducing the amount they have to work and helps the patient eliminate/blow off CO2.
CPAP?
- Support patients in acute hypoxic respiratory failure or to assist with weaning from invasive ventilation
- Provides a constant pressure during inspiration and expiration
(Type 1 respiratory failure)
BiPAP?
- Delivers variable levels of pressure unlike CPAP which is
continuous positive pressure - Different pressures for inhalation and exhalation
(type 2 respiratory failure)
What is an LMA? How is it inserted?
- Supraglotic device - mask which sits over the laryngeal opening
- Often used for short procedures
- Do not use if risk of aspiration as doesn’t completely block off the oesophagus
- Hold finger at the base of LMA, tilt patients head, push against hard palate with open side facing the tongue, walking finger up tube as you insert until resistance is felt, inflate the cuff, attach to bag, keep ventilating via bag.
- Often used for short procedures
What is the process of induction when using an LMA?
- Oxygenation
- Opioid: fentanyl/alfentanil
- Induction agent: propofol
- Turn on inhalational agent: sevoflurane, isoflurane,
desflurane - Bag and valve mask ventilation
- LMA insertion
Process of induction when using an ET tube?
- Oxygenation
- Opioid (fentanyl/alfentanil)
- Induction agent (propofol)
- Turn on inhalational agent (sevoflurane, isoflurane, desoflurane)
- Bag valve mask ventilation (not in RSI as blow air into the stomach and will increase risk of aspiration)
- Muscle relaxant: non depolarising agent unless RSI then use suxamethonium
- Endotracheal intubation
How do you confirm the position of an ET tube?
- Measure CO2 in expired gas
- Auscultate all over the lungs, especially bases to ensure tube isn’t in one bronchus
- Direct visualisation of tube passing through cords
- Fogging on tube
Early complications of ET intubation?
- Trauma to any section of the airway including the mouth, teeth, trachea
- Aspiration of stomach contents
- Tube malposition
- Airway obstruction
- Hypoxia from prolonged attempts
Late complications of ET intubation?
- Infection
- Mucosal damage to mouth or trachea from cuff pressure
- Injury to vocal cords
- Tracheal stenosis
What is the purpose of an acute tracheostomy?
emergency to obtain an airway in ventilated patients who
are having difficulty weaning off the ventilator
Purpose of chronic/elective tracheostomy?
patient needs to be ventilated long term
Indications of tracheostomy?
- Obstruction of upper airway: foreign body, trauma, infection, laryngeal tumour, facial fractures
- Impaired respiratory function: head trauma leading to unconsciousness, bulbar poliomyelitis
- Assist weaning from ventilation in ICU patients
Indication for cricothyroidectomy?
Temporary emergency airway in situations where there is obstruction at or above the level of the larynx
