Airway Management and Intubation Flashcards
What might gurgling indicate?
Fluid in mouth/upper airway
What might snoring indicate?
Pharynx partially obstructed by tongue
What might crowing indicate?
Laryngeal spasm
What might inspiratory stridor indicate?
Obstruction at/above larynx
What might expiratory wheeze indicate?
Airway collapse during expiration
What can cause upper airway obstructions?
- Tongue obstructing pharynx: i.e. sedation/neurological compromise
- Vomit/secretions/blood/gastric fluid
- Tissue swelling: i.e. trauma/allergy/infection
What can cause lower airway obstructions?
- Laryngeal oedema: i.e. burns/inflammation/allergy
- Laryngeal spasm: i.e. FB/airway stimulation/secretions or blood in airway
- Tracheobronchial obstruction: i.e. secretions/inhaled gastric contents/pulmonary oedema/bronchospasm
What are the 2 main airway manoeuvres
- Chin lift
- Jaw thrust
When is a chin lift contraindicated
Suspected/confirmed c-spine injury
What are the 2 main types of airway adjuncts
- OPA (guedel)
- NPA
How does an OPA work to maintain airway patency?
- Prevents tongue occluding airway
How is an OPA measured?
- Central incisors to angle of jaw
How is an OPA inserted?
- Upside down and then turned 180 degrees
When is an OPA contraindicated?
- Intact gag reflex
–> can induce vomiting/aspiration
How does a NPA work to maintain airway patency?
Sits between nostril and nasopharynx above epiglottis
How is a NPA measured?
- Tip of nose to tragus of ear
How is a NPA inserted?
- Lubricate end (ensure opening isn’t occluded) and insert along floor of nasopharynx
When is a NPA contraindicated?
- Basal skull #
- Nasal trauma
- Coagulopathy
Which nostril is the preferred nostril for NPA insertion and why?
- Right
- Generally larger and straighter
What is the use of a BVM?
- Delivering additional breaths to patients with low RR
- Manual ventilation of apnoeic patients
Can BVM be used on spontaneously breathing patient?
- Yes but must be generating enough negative pressure to open inspiratory valve otherwise won’t receive any O2
How do you measure a mask for BVM?
Bridge of nose to cleft of chin
How do you insert LMA?
- Partially deflate and lube cuff
- Insert
- Reinflate cuff
What are the two options for a surgical airway?
- Surgical airway
- Needle cricothyroidectomy
What is the preferred emergency surgical airway in paediatrics?
- Needle cric preferred for kids under 10
–> Cricothyroid membrane is underdeveloped
How do you intubate a patient requiring c-spine precautions
Manual in-line stabilisation
–> dedicated person to maintain c-spine
- 2 techniques:
> crouch behind patient next to person tubing - Stand beside patient with forearms resting on patient’s chest
What is laryngeal manipulation?
- BURP (backwards upwards rightwards pressure)
–> can improve visualisation of vocal cords
What is the ideal position for intubation?
- ears align with sternal notch
- may require pillows / troop elevation pillow
