Airway Management Ch. 37 & 38 Flashcards
What are the different routes for airway management?
•Pharyngeal
•Artificial
•Intubation
What is a pharyngeal airway?
Airways that extend only into the pharynx
What are artificial airways?
Airways that are placed into the mouth and nose into the trachea.
Ex. ET tubes
What is intubation?
The process of placing an artificial airway into the trachea
What are the 2 types of intubation?
Orotracheal & Nasotracheal
What are the 2 types of pharyngeal airways?
Nasopharyngeal & oropharyngeal
Why do we use a nasopharyngeal airway?
To minimize damage to the nasal mucosa
What is the benefit of oropharyngeal?
Maintain patient airway by preventing tongue from obstruction of the oropharynx separates tongue from posterior pharyngeal wall, can be used as by bite block.
What are the 2 types or oropharyngeal airways?
Berman- 2 side channels
Guedel- single centered channel
How do you size a pharyngeal airway?
To choose an airway of the correct size, the clinician should place the devices on the side of the patient’s face with the flange even with the patient’s mouth. The correct size airway measures from the corner of the patient’s mouth to the angle of the jaw following the natural curve of the airway.
When do use an oropharyngeal airway?
Only on unconscious patients
What can happen if the oropharyngeal airway is too large?
It can push the epiglottis against the larynx leading to airway obstruction.
What can happen if the oropharyngeal airway is too small?
It may not clear the tongue which could lead to obstruction
How should the oropharyngeal airway be placed in patients mouth?
It must be placed in the mouth then turned at a 180 degree angle and then the tip of the oropharyngeal airway lies at the base of the tongue above the epiglottis, with the flange portion extending outside the teeth.
When should we never use an oropharyngeal airway?
When there is trauma to the oral cavity or the mandibular or maxillary areas of the skull. These airways should never be placed when either a space-occupying lesion or a foreign body obstructs the oral cavity or pharynx.
What type of pts are nasopharyngeal airways used for?
For emergent and suctioning pts when the oropharyngeal route is unavailable.
What are other names for nasopharyngeal airway?
Nasal trumpet and nasal horn
What are some indications of nasopharyngeal airway
- Facilitate ventilation
- Removal of secretions by nasotracheal suctioning
What are the uses & precautions?
- Inspect nares for obstruction
- Use local anesthetic spray
- Use water soluble lubricant on airway
What are oropharyngeal airways used for?
Obstruction
What is the size for a female for the nasopharyngeal airway.
Size 6
What is the size for a male for the nasopharyngeal airway?
Size 7
What can happen if the nasopharyngeal airway is too short?
It cannot separate the soft palate form posterior wall of pharynx.
What happens if the nasopharyngeal airway is too long?
It can enter the larynx causing laryngeal reflexes or enter between epiglottis or vacuella, leading to obstruction.
When do you use nasopharyngeal airways.
For semi-conscious (awake) pts
How do you measure the appropriate size for nasopharyngeal airway.
Measure the appropriate size by going from pts earlobe to tip of nose insert airway parallel to nasal floor beveled edge towards septum.
Where is an EOA located?
In the esophagus
What does EOA stand for?
Esophageal obturator airway
What is unique about an EOA?
It has openings at the top end for manual ventilation, small holes in the midsection to divert air to the lungs, a blind distal end which prevents air from going into the stomach and a cuff on top of the distal end which prevents aspiration of stomach contents.
What could happen when entering an EOA?
Asphyxia (suffocation) & tracheal damage could occur.
When can an EOA not be used?
As an airway for PPV
Can an ET intubation be done with EOA in place?
Yes
Is the ET tube secured before manual removal of EOA?
Yes
What does LMA stand for?
Laryngeal mask airway
What is an LMA? And what does it do?
A short ET tube with small cushion to oblong shaped mask on distal end. Provides a seal over larynx with max cuff pressure of 60 cmH2O.
What are the indications for an LMA?
-Airway during CPR in profoundly unconscious patients without glossopharyngeal and laryngeal reflexes.
-Unable to perform ET intubation
What are some contraindications for an LMA?
•Does not protect airway from aspiration
•should not be used in patients who have not fasted or not profoundly unconscious
•have severe oropharyngeal trauma require EM resuscitation drug
What are the sizes for an adult and infant for an LMA?
Size 1 for infants, size 5 for adults
What are limitations for an LMA?
- Unstable airway may cause misplacement and gastric insufflation
- cannot withstand high airway. pressures
- not meant for long-term use
- does not protect lower airway from aspiration requires steam auto clave.
What is the maximum cuff pressure for an LMA?
60
What is the max airway pressure for an LMA?
20
What does ETC stand for?
Esophageal tracheal Combitube
What is an ETC? Where can it be inserted.
A double lumen airway that is blindly inserted. It can be inserted into the esophagus or trachea.
What happens when the ETC is in the esophagus?
It seals off the esophagus with a small distal cuff 15 mL
What happens when the ETC is in the trachea?
It seals off the trachea with a large proximal cuff 100 mL
What does DLT stand for?
Double lumen endotracheal tube
What are some indications of artificial airways?
-Relief of airway obstruction
-Protection of airway
-Suctioning
-Support ventilation
What is the biggest form of airway obstruction?
The tongue
What is an ETT used for?
Oral intubation, uncomfortable gagging excessive secretions
When do we use nasal intubation?
When oral route is not available (not as common). It’s harder to insert, smaller ET tube with higher airflow resistance, incidence of sinusitis.
What is tracheotomy?
Procedure best perform by physician or surgeon in surgical setting after airway is stabilized
What is tracheostomy?
Tracheostomy is a hole that surgeons make through the front of the neck and into the trachea. A tracheostomy tube is placed into the hole to keep it open for breathing.
How should a tracheostomy tube be placed?
Tracheostomy tubes should be two-thirds the diameter of the trachea and should project within the borders of the trachea on the radiograph. The tip should extend beyond half the distance from the stoma to the carina.
What is an obturator?
An obturator with a rounded tip is used for tube insertion. Before insertion, the obturator is placed within the outer cannula, with its tip extending just beyond the far end of the tube; this minimizes mucosal trauma during insertion.
Where should an obturator be kept?
In a bag somewhere visible inside the room
What is a speaking valve?
A one-way valve that allows inspiration, but not exhalation through the tracheostomy tube opening
Where does the exhaled air come from when patient has speaking valve.
Exhaled air is forced to go through the vocal cords, making phonation possible
What should always be deflated on a tracheostomy tube?
The cuff
What does a traditional tracheostomy tube look like?
Solid with no holes to allow for closed circuit ventilation.
What does a fenestrated tracheostomy tube look like?
has a special speech cannula that allows ventilator-dependent patients to speak with the cuff fully inflated. With the speech cannula inserted during inhalation, the flap valve opens and the flexible bubble valve expands, blocking the fenestrations. During exhalation the flap valve closes and the bubble valve collapses, which allows air to pass through the fenestrations, so the patient can speak
When can a cuff of a tracheostomy tube be inflated?
Cuff should be inflated when using with ventilators.
Cuff should be inflated just enough to allow minimal airleak.
When the inner solid cannula of the fenestrated tracheostomy is removed.
When should cuff be deflated on a tracheostomy tube?
When patient is using a speaking valve
What can happen if the tracheostomy is done incorrectly and cuff is inflated?
The patient can suffocate
What is this a picture of?
What are the different parts?
Jackson Tracheostomy Tube Made From Stainless Steel.
It has no cuff and no 15-mm adapter.
(A) Obturator
(B) Outer cannula.
(C) Inner cannula.
What are the parts of a tracheostomy tube?
What is the equipment needed for endotracheal intubation?
- Blade
•Mac or Miller - ET tube securing device
What is this a picture of?
Endotracheal and tracheostomy tubes with subglottic suction ports.
What is the purpose of a stylet?
To add rigidity and maintain shape during insertion. The tip of the stylet must never extend beyond the ETT tip.
Why should a stylet never come out the tip of the ET tube?
Because it can pop a lung
Why do we use water soluble lubricating gel?
used for lubrication of tracheal tubes to reduce airway injuries and friction caused by intubation
How do we know if an ET tube is in the trachea?
CO2 detector will change color
Either blue and yellow or yellow to purple
What is a picture of?
Endotracheal tube adapter for jet ventilation. LifePort adapter.
What is this a picture of and what are they used for?
Laryngectomy tubes
A laryngectomy tube is a shorter tube without a cuff inserted into the stoma after a laryngectomy. The tube keeps the stoma open until it heals. There are several different types, some with a flange that can be secured with a fastener around the patient’s neck and some without a flange (low profile). The tube may be easily removed to be cleaned and then reinserted
What are the two types of laryngoscope blades? Where are they placed?
Mac (vallecula) & Miller (epiglottis)
