Airway management and ventilation Flashcards
What are the basic techniques for opening the airway?
head tilt
chin lift
jaw thrust
How is a jaw thrust carried out?
Identify the angle of the mandible
With the index and other fingers behind the anlg, apply steady upwards pressure to lift the mandible
Using the thumbs slightly open the mouth by downward displacement of the chin
If a clear airway cannot be achieved by manoeuvres what should be done?
Look for other causes
- remove any visible foreign body with forceps or suction
- remove broken or displaced dentures- leave well fitting dentures in place
What are oropharyngeal and nasopharyngeal airways designed to do?
Overcome the soft palate obstruction and backward tongue displacement
What is the downside of oropharyngeal and nasopharyngeal?
jaw thrust may also be required
How do you size a guedel?
Length should correspond to length of patients incisors and angle of the jaw
what is the technique for inserting a guedel?
Open the mouth and ensure no foreign material
insert into airway “upside down”as far as the junction between hard and soft palate then rotate 180, advance until it lies in the pharynx
What is the benefit of a nasopharyngeal airway?
Better tolerated in patients who are not deeply unconscious
may be lifesaving in patients with clenched jaws, trismus or maxilofacial injuries
Is a base of skull fracture an absolute contraindication of nasopharyngeal airway
No
What size of nasopharyngeal airway should be used in adults?
6-7mm
What can happen if a nasopharyngeal airway is too long?
Stimulate the laryngeal or glossopharyngeal reflexes to produce laryngospasm or vomitting
What is the highest level of O2 a reservoir mask can provide?
85% at 10L min
What oxygen concentration does rescue breathing provide?
16-18%
What 02 percentage does a self-inflating bag not connected to an outlet provide?
21%
If the self inflating bag is connected to 02 what is the max percentage?
85%
If an airway isn’t patent when bagging what can happen?
Force air into the stomach causing vomiting and regurgitation
What is the benefit of automatic resuscitators?
- In unintubated patients the rescuer has both hands free
- in intubated patients they free the rescuer for other tasks
- once set, they provide a constant tidal volume, respiratory rate and minute ventilation; thus, they may help to avoid excessive ventilation
What size of igel will fit most adults?
4
How do you insert an iGel?
- select the size
- lubricate the back and sides
- grasp across the bite block and face the outlet towards the chin
- ensure the patient is sniffing the morning air and gently press the chin down before inserting
- insert the soft tip into the mouth in the direction of the hard palate
- glide the device back and downwards along the hard palate with a gentle push until a definitive resistance is felt
What should be done if there is early resistance during insertion
get a colleage to do a jaw thrust
How do you assess clinically if a patient is adequately ventilated?
- observation of chest expansion bilaterally
- auscultation over the lungs bilaterally
- auscultation over the epigastrium (breath sounds should not be heard)
- condensation in the tube
secondary confirmation is with waveform capnography- this will not differentiate between a tube placed in a main bronchus and one placed in a trachea
What indicates correct tube placement on a CO2 monitor?
persistence of exhaled C02 after six ventilations
What are the two main types of C02 detectors?
- end-tidal CO2 detectors
- non-waveform electronic digital end-tidal CO2 detectors
What should not be attempted if waveform capnography is not available?
intubation
