Airway Management Flashcards
State 4 main structures of the Upper Respiratory Tract
Nose
Mouth
Pharynx
Epiglottis
The Nose, Mouth, Pharynx and Epiglottis are all part of what?
The Upper Respiratory Tract.
Describe the function of the Nose and Mouth
Intake of air
Warming and humidification of air
Filtering and expulsion of matter - sneezing
What is the Pharynx?
Cavity at the back of nose and mouth
What is the Cavity at the back of nose and mouth called?
The pharynx
What is the Epiglottis and its function?
Leaf shaped structure which closes to protect airway during swallowing
what is the name Leaf shaped structure which covers the trachea during swallowing?
The epiglottis
Where can the vocal chords be found?
In the larynx
What can be found in the larynx
vocal chords
How long does the trachea extend?
from the larynx to fifth thoracic vertabrae
What is dead space and why does it occur?
The volume of air which does not participate in gas exchange because either it remains in the conducting airways or enters a poorly perfused alveoli
What is Tidal volume?
The volume of air moved in or out of the tracheobronchial tree in a normal breath
How do you work out minute volume?
Tidal volume x respiration rate
How do you work out alveolar ventilation rate??
minute voulome -dead space.
Why are humans vulnerable to airway obstruction and aspiration?
unconsciuosness allows tongue to fall back into pharynx
proximity of oesophagus to airway - loss of glottic closure
Who is most vulnerable to airway obstruction?
any patient with altered concious state
any patient witnh loss of swallow cough gag reflexes
any patient with mechanical injury or obstruction
What is aspiration in acute medical situations?
Inhilation of of materials other than air into the airway
Give examples of common aspirants.
Mucus, Saliva, stomach contents.
Why can aspiration be dangerous?
increased risk of aspiration pneumonia.
Can cause a pulmonary edem (fluid in lungs) resulting in less o2 uptake
What are the indication for oral intubation?
Hypo ventilation unfavovourable abg results gcs<8 Trauma Surgery airway protection drug overdose
What should be considered if a patient has to be intubated?
Does patient require ITU bed
What is the purpose of intubation?
What is the underlying condition for intubation
What specific nursing consideration should be taken when intubating a patient?
equipment drugs patient prep procedure ventilation post-intubation? observations documentation
What complications might
occur during orotracheal
intubation?
intubation of oesophagus
upper airway and nasal trauma, Tooth avulsion, laceration
When is cricoid pressure applied?
during intubation of a patient where nil-by-mouth cannot be ascertained or where gastric reflux is likely.
What is Cricoid pressure?
also known as sellick manoeuvre is a technique used for the endotracheal intubation of patients to reduce the risk of regurgitation
It involved applying pressure on th cricoid cartillage, compressing the esophagus and thus exposes vocal chords.
What’s different in the asessment of total obstruction and partial obstruction?
Total obstruction in silent, partial obstruction is associated with noise
List the hierarchy of airway management (9)
Airway clearance
recovory position
head-tilt, chin lift manoevre
oropharyngeal airway (guedel)
Nasopharyngeal airway
Bag, valve mask - 2 person ventilation
supraglottic airway
oral (maybe nasal?0 cuffed endotracheal tube
tracheostomy
hich form of airway management is considered the gold standrd?
ETT - Endotracheal tube
Describe how the recovery position lookes like.
patient on left side
right hand underneath cheek, other arm bent out to prevent rolling
lft leg bent out to support position
What airway/breathing equipment may be found in the crash trolley?
laryngoscope
stylet
working suction
cardiac monitor,
pulse ocimeter
capnograph
In an arrest situation are drugs required?
No - not priority, start CPR
What drugs may be involved in rapid sequnce intubation or elective intubation?
sedation/induction agent
muscle relaxant
atropine
Reversal agens for lng acting muscle relaxants
When administering a sedation/induction agent, what should be checked and how?
check BP and pulse by lacing finger on pule
once practicible check bp
What are the contraindications for nasopharyngeal airway?
someone with a head injury because there is a posibilty it could reach the brain
How should you prepare patient for intubation?
- position on back
- suction on
- Pre-oxygenate using bag-valve mask
describe the difference between a McItosh and a Straight curved blade laryngascope
McIntosh is cuved, tip lies in vallecula, blade displaces tongue and tissues forward
Miller, tip lifts epiglottis, blade flattens tissues with les displacement. ueful for children, anterior larynx, obesity
What complications might occur during orotracheal intubation?
Trauma
How is tube placement of the ETT verified?
Increase end tidal co2
What is capnography?
also known as End Tidal CO2.
Monitors amount/concentration/partial pressure of Co2 in respiratory gases
What is the purpose of Positive Pressure ventilation (PPV)?
Protect and manage airway – suction, balloon inflated
prevents aspiration
Ability to manipulate ventilation to improve blood gases and
reverse acidosis –
Increase tidal volumes to blow off CO2 and increase alveolar
ventilation
Can control respiratory rate
Can apply modes of ventilation that allow patient to do some
breathing
What are the complications of Pstive presssure ventilation?
Protect airway – risk of tube blockage
Invasive ventilation increases risk of chest infection, ventilator acquired pneumonia
(VAP)
Presence of oral tube very uncomfortable for patient so need for sedation
Risk of biting down on tube
Oral hygiene difficult (VAP?)
Large tidal volumes can cause barotrauma
High O2
levels can cause inflammation – risk of ARDS
what is non-invasive ventilation (niv)?
the provision of
ventilatory support through the patient’s upper airway
using a mask or similar device’
This may be:
• Continuous positive airway pressure (CPAP) or
• Bilevel positive airway pressure (BiPAP
wHAT IS THE AIMS OF NON-INVASIVE VENTILATION?
- Decreased work of breathing
- Increased tidal volume
- Decreased respiratory rate
What are the aims for non-invasive ventilation?
- Decreased work of breathing
- Increased tidal volume
- Decreased respiratory rate
What are the indications for non-invasive ventilation?
Acute respiratory failure
Hypercapnic acute respiratory failure
Post-extubation difficulty
Weaning difficulties
Post-surgical respiratory failure
Acute respiratory failure in obesity hypoventilation syndrome
Patients ‘not for intubation’
Hypoxaemic acute respiratory failure-there is limited evidence to support the use of NIV, but patients presenting with cardiogenic
pulmonary o
How do you insert a guedell into patient?
Insert upside down first in mouth then rotate.
What does MAP stand for?
Mean Arterial Blood pressure
