Airway Management Flashcards
1
Q
Causes of inadequate airway
A
- impaired laryngeal reflexes
- obstruction
- mucosal inflammation and thickening
- acute respiratory failure
2
Q
Signs of inadequate airway
A
- voice alteration, hoarseness
- tachycardia, tachypnoea, sweating
- anxiety, confusion, lethargy
- gurgling
- drooling
- choking, gagging
- inspiratory stridor, crowing
- hypercarbia, hypoxaemia
3
Q
Methods of maintaining a clear airway
A
- positioning
- jaw position
- nebulised adrenaline
- suctioning
- oropharyngeal/nasopharyngeal airway
- endotracheal tube
- tracheostomy
4
Q
Positioning
A
- upright side lying
- chin lift manoeuvre
- jaw thrust (if suspected spinal injury)
5
Q
Oropharyngeal/Guedel’s airway
A
- short plastic tube to pharynx only
- keeps airway open
- facilitates suction
- insertion can cause patient to gag or vomit
- Care with loose teeth and bite reflex
- **If patient can tolerate it, they need it
6
Q
Nasopharyngeal airway
A
- soft silastic tube to pharynx
- inserted with lubricant
- changed several times per day
7
Q
Nasopharyngeal airway precautions
A
- nasal/facial fractures
- CSF leak
- torn dura
- coagulopathy
- anticoagulant therapy
- hypotension
8
Q
Intubation
A
- to just above carina
- inserted by medical staff
- only access to ventilation
- often requires sedation
- condition must be reversible
9
Q
Intubation indications
A
- airway obstruction
- inadequate oxygen
- inadequate ventilation
- elevated WOB
- airway protection
- facilitation of tracheobronchial suctioning
- facilitation of mechanical ventilation
10
Q
Intubation complications
A
- trauma
- malposition
- obstruction
- disordered physiology
- increased secretions
- decreased cilial activity
- inability to cough
- infection
- inability to talk/swallow
- lack of humidification (so need to humidify)
11
Q
Endotracheal tube
A
- larger
- less well tolerated
- tube occlusion by biting
- damage to patients’ teeth
12
Q
Nasotracheal tube
A
- oral hygiene easier
- easier to insert
- smaller –> easier to block with secretions
- can cause sinus infections and nose bleeds
13
Q
Cuffed ETT
A
- prevents aspiration of gastrointestinal contents
- provides good seal for ventilation
- prevents movement/holds tube in
- low pressure/high volume
14
Q
Cuffed ETT indications
A
- unconscious
- unable to swallow
- requires full mechanical ventilation
- can cause damage to vocal chords
15
Q
Uncuffed ETT
A
- awake or able to swallow
- paediatric use
- able to speak
- may cause increased secretions (irritation and movement)
16
Q
Tracheostomy
A
- short tube inserted cricoid cartilage
- reaches carina
- reduces anatomical dead space
17
Q
Tracheostomy indications
A
- long term intubation
- prevent laryngeal damage and oedema from ETT
- ETT not well tolerated if patient not sedated
- URT obstruction
- facilitation of suctioning
- permanent bypass obstruction or tumour
18
Q
Tracheostomy complications
A
- operative risks
- placement in pre-tracheal tissues
- haemorrhage of innominate artery
- tracheal stenosis
- tracheomalacia
- trachea-oesophageal fistula
- surgical emphysema
- blockage with secretions
19
Q
Surgical tracheostomies
A
- in OT
- actual dissection
- ± removal of cricoid cartilage
- for patients with “difficult airways” (thick, short necks)
20
Q
Percutaneous tracheostomies
A
- in ICU
- dilatation technique
- no scar
- avoid transport of critically ill patient
21
Q
Minitracheostomy
A
- inserted for secretion removal only
- maintain own airway, eat, talk
- no need for humidification
- may need NaCl 0.9% during suction
- size 8 or 10 FG catheter to suction
22
Q
Weaning from tracheostomy
A
- ACTs
- huffing
- smaller trachy
- spigotting
- swallow assesments
- fenestrated trachy tubes
- stomal button
- trachae teams
- one way valves (Passy Muir)
23
Q
Suctioning indications
A
- artificial airway
- unconscious
- inability to cough and effectively expectorate secretions
24
Q
Suctioning precautions
A
- pulmonary oedema
- haemoptysis
- respiratory burns
- head injuries
- high levels PEEP, FiO2
- severe infection
25
Q
Suctioning complications
A
- hypoxaemia
- cardiac arrhythmias
- haemodynamic alterations
- increased ICP
- gastric aspiration
- trauma
- distress
- atelectasis
- reflex bronchospasm
- infection
26
Q
Alternatives to suctioning
A
- increase FiO2 on ventilator
- manual hyperinflation
- efficient technique, reassurance
- closed suction systems
27
Q
Closed suction systems
A
- prevents disconnection from ventilator (prevents loss of FRC and O2)
- prevents pathogens sprayed into air
- not always effective if thick secretions
