Airway management and ventilation

Question 1

Where does the upper airway meet the lower airway

Answer 1

-at the glottis= opening between vocal cords

Question 2

3 questions to assess airway and breathing

Answer 2

-is the airway patent (open)
-is there ventilation(breathing) occurring
-is it sufficient

Question 3

Common site of airway obstruction

Answer 3

pharynx

Question 4

What does it mean if patient talking

Answer 4

-their airway isn’t completely
obstructed
-but if you can see or hear a patient breathing as you approach, there’s usually a problem

Question 5

Step wise approach to airway and ventilation

Answer 5

-manual methods- HTCL
-OPA (oropharyngeal airway), NPA(nasopharyngeal airway, BVM(Bag-valve-mask
-supraglottic airway
-endotracheal intubation
-needle cricothyrotomy
-surgical airway

Question 6

Manual methods

Answer 6

-HTCL- head tilt chin lift
-jaw thrust- fingers placed in angle of mandible and pressure applied upwards and forwards. Open mouth with thumbs

Question 7

Check breathing and pulse

Answer 7

-look chest rise and fall
-listen and feel for airflow
-check carotid pulse
-do for 10 seconds

Question 8

Inspiratory/ expiratory stridor

Answer 8

-caused by obstruction at laryngeal or upper tracheal level
-either by physical object or swelling

Question 9

Expiratory wheeze

Answer 9

-obstruction of lower airways
-airways tend to narrow and obstruct during expiration

Question 10

Signs of complete airway obstruction

Answer 10

-paradoxical chest and abdominal movement
-described as ‘see-saw’
-chest drawn in, abdomen expands, opposite during expiration

Question 11

Cyanosis

Answer 11

when skin turns blue due to lack of oxygen in blood

Question 12

Causes of airway obstruction

Answer 12

-infection
-severe allergic reaction leads to laryngeal oedema(swelling)
-tongue, soft palate and epiglottis
-foreign body airway obstruction
-laryngeal spasm- vocal cords jam shut
-fractured larynx- rare but caused by a direct blow to the throat
-aspiration- stomach contents track back into lungs

Question 13

Signs moderate airway obstruction and what to encourage them to do

Answer 13

-conscious, ale exchange air
-degree of respiratory distress
-noisy respirations, coughing
-encourage to give forceful cough

Question 14

Signs of severe airway obstruction

Answer 14

-sudden inability to breathe, talk or cough
-grabs at throat

Question 15

What to do with patient with suspected airway obstruction

Answer 15

-ask choking
-if yes begin treatment
-if unresponsive look in airway for obstruction
-open airway
-ventilate if not breathing

Question 16

How to remove obstruction

Answer 16

-sweep forward out of mouth with gloved index finger
-don’t blind finger sweep as may push obstruction further
-may use suction to clear airway

Question 17

Performing abdominal thrust

Answer 17

COMPLETE 5 TIMES
-stand behind victim
-one leg between victims legs
-head to one side
-make fist with one hand, thumb side in victim’s abdomen (just below where ribs come together)
-grab fist with other hand
-thrust inward and upward

Question 18

Abdominal thrust on pregnant victim

Answer 18

-you can’t get arms around
-so give chest thrusts
-exactly same as abdominal, but just on the sternum not stomach

Question 19

What to do when child choking

Answer 19

Effective cough
-encourage cough
-continue check deterioration
Ineffective cough:
-conscious- 5 back blows, 5 thrusts (infant=chest thrusts, over 1 yrs= abdominal)
-unconscious- 5 breaths, CPR

Question 20

What to do if infant under 1 is choking

Answer 20

-lay on leg, support neck
-5 back slaps between shoulder blades
-roll infant face up
-check for expelled object
-5 chest thrusts
-use 2 fingers side by side on sternum, just below mid nipple line

Question 21

When to use suction equipment

Answer 21

-mouth full vomit, blood, excess saliva
-if you hear gurgling

Question 22

Main suctioning equipment

Answer 22

-main/ battery suction unit- on wall of ambulance
-portable suction unit
-hand powered

Question 23

Mechanical/ vacuum powered suction units

Answer 23

-amount of suction adjustable for children and intubated patients
-check at beginning of every shift

Question 24

Yankauer (rigid) suction catheter

Answer 24

-large rigid tube, multiple holes in end
-large volumes fluid

Question 25

Soft catheter

Answer 25

-long flexible tube
-small diameter
-used in nasal airways or inside oral airways

Question 26

Suctioning technique

Answer 26

-attach catheter to tubing
-ensure measure proper depth of insertion- corner mouth to ear lobe
-insert catheter to pre measured depth, turn on suction
-suction in small circular motions as you withdraw catheter
-adult= 15 seconds
-child= 10 seconds
-infant= 5 seconds

Question 27

Using laryngoscope and magill’s forceps

Answer 27

-use laryngoscope to keep tongue out way and visualise obstruction
-use magill’s forceps to remove obstruction

Question 28

When to use oropharyngeal (guedal) airway (OPA) and advantages, disadvantages

Answer 28

-used unconscious patients with no gag reflex
-if patient becomes conscious, remove it
-easy to put in
-prevents blockage tongue
-don’t prevent aspiration- choking vomit

Question 29

Inserting OPA for adults

Answer 29

INVERT, INSERT, ROTATE
-select proper size, measure mouth to angle of jaw
-open patients mouth, pull down lower jaw
-insert OPA tip facing roof of mouth
-advance while rotating 180
-continue until flange rests on teeth

Question 30

Who to use naso-pharyngeal airway on (NPA)

Answer 30

-use unresponsive, but still have gag reflex
-people who can’t tolerate OPA eg. clenched jaw, maxillo-facial injury, conscious patients

Question 31

When not to use NPA

Answer 31

-patient with suspected base of skull fracture- as danger of entering cranial cavity

Question 32

Side effects NPA

Answer 32

-nasal bleeding (around 30%)
-placed too deep can induce vomiting or laryngospasm

Question 33

Inserting NPA

Answer 33

-sizing- tip of nose to ear lobe
-adults= 6,7,8
-lubricate airway
-generally place in right nostril
-gently push nostril open
-bevel turned toward septum, insert airway

Question 34

Bag Valve Mask ventilation (BVM)- aim

Answer 34

Aim- sufficient oxygenation to maintain cerebral oxygenation

Question 35

Adult bag volume

Answer 35

1200-1700 ml
-don’t have to squeeze the bag too much to get a normal adult tidal vol into patient (500ml)

Question 36

Volume we should aim for when using BVM

Answer 36

-6-8 ml/kg
-therefore 70kg= 420-480 ml
-adults rate of 12 inflations per min
-in practice vol can’t be measured so deliver a volume that produces visible chest movement

Question 37

Challenges BVM

Answer 37

-maintaining seal of mask against face
-one person must keep airway properly positioned, maintain mask seal and squeeze bag

Question 38

CE mask grip (BVM)

Answer 38

-make C out of thumb and forefinger of dominant hand, this goes around mask and push down
-other 3 fingers grip under angle of jaw and provide jaw thrust making letter E

Question 39

Difficult patient examples when using BVM

Answer 39

HBONE
-hollowed cheeks
-beard- can place cling film over beard to get good seal
-obese
-no teeth
-elderly

Question 40

What too do if chest isn’t rising and falling when using BVM

Answer 40

-reposition head, insert airway
-too much air escaping, reposition mask
-try 2 handed technique