Airway management and ventilation Flashcards
Where does the upper airway meet the lower airway
-at the glottis= opening between vocal cords
3 questions to assess airway and breathing
-is the airway patent (open)
-is there ventilation(breathing) occurring
-is it sufficient
Common site of airway obstruction
pharynx
What does it mean if patient talking
-their airway isn’t completely
obstructed
-but if you can see or hear a patient breathing as you approach, there’s usually a problem
Step wise approach to airway and ventilation
-manual methods- HTCL
-OPA (oropharyngeal airway), NPA(nasopharyngeal airway, BVM(Bag-valve-mask
-supraglottic airway
-endotracheal intubation
-needle cricothyrotomy
-surgical airway
Manual methods
-HTCL- head tilt chin lift
-jaw thrust- fingers placed in angle of mandible and pressure applied upwards and forwards. Open mouth with thumbs
Check breathing and pulse
-look chest rise and fall
-listen and feel for airflow
-check carotid pulse
-do for 10 seconds
Inspiratory/ expiratory stridor
-caused by obstruction at laryngeal or upper tracheal level
-either by physical object or swelling
Expiratory wheeze
-obstruction of lower airways
-airways tend to narrow and obstruct during expiration
Signs of complete airway obstruction
-paradoxical chest and abdominal movement
-described as ‘see-saw’
-chest drawn in, abdomen expands, opposite during expiration
Cyanosis
when skin turns blue due to lack of oxygen in blood
Causes of airway obstruction
-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
Signs moderate airway obstruction and what to encourage them to do
-conscious, ale exchange air
-degree of respiratory distress
-noisy respirations, coughing
-encourage to give forceful cough
Signs of severe airway obstruction
-sudden inability to breathe, talk or cough
-grabs at throat
What to do with patient with suspected airway obstruction
-ask choking
-if yes begin treatment
-if unresponsive look in airway for obstruction
-open airway
-ventilate if not breathing
How to remove obstruction
-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
Performing abdominal thrust
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
Abdominal thrust on pregnant victim
-you can’t get arms around
-so give chest thrusts
-exactly same as abdominal, but just on the sternum not stomach
What to do when child choking
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
What to do if infant under 1 is choking
-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
When to use suction equipment
-mouth full vomit, blood, excess saliva
-if you hear gurgling
Main suctioning equipment
-main/ battery suction unit- on wall of ambulance
-portable suction unit
-hand powered
Mechanical/ vacuum powered suction units
-amount of suction adjustable for children and intubated patients
-check at beginning of every shift
Yankauer (rigid) suction catheter
-large rigid tube, multiple holes in end
-large volumes fluid
Soft catheter
-long flexible tube
-small diameter
-used in nasal airways or inside oral airways
Suctioning technique
-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
Using laryngoscope and magill’s forceps
-use laryngoscope to keep tongue out way and visualise obstruction
-use magill’s forceps to remove obstruction
When to use oropharyngeal (guedal) airway (OPA) and advantages, disadvantages
-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
Inserting OPA for adults
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
Who to use naso-pharyngeal airway on (NPA)
-use unresponsive, but still have gag reflex
-people who can’t tolerate OPA eg. clenched jaw, maxillo-facial injury, conscious patients
When not to use NPA
-patient with suspected base of skull fracture- as danger of entering cranial cavity
Side effects NPA
-nasal bleeding (around 30%)
-placed too deep can induce vomiting or laryngospasm
Inserting NPA
-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
Bag Valve Mask ventilation (BVM)- aim
Aim- sufficient oxygenation to maintain cerebral oxygenation
Adult bag volume
1200-1700 ml
-don’t have to squeeze the bag too much to get a normal adult tidal vol into patient (500ml)
Volume we should aim for when using BVM
-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
Challenges BVM
-maintaining seal of mask against face
-one person must keep airway properly positioned, maintain mask seal and squeeze bag
CE mask grip (BVM)
-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
Difficult patient examples when using BVM
HBONE
-hollowed cheeks
-beard- can place cling film over beard to get good seal
-obese
-no teeth
-elderly
What too do if chest isn’t rising and falling when using BVM
-reposition head, insert airway
-too much air escaping, reposition mask
-try 2 handed technique
