Airway Management - CPAP, Stomas, Obstructions, & ALS Assist Flashcards
Alveolar collapse
Atelectasis
What does the CPAP do?
Increases pressure in the lungs, opens collapsed alveoli and prevents further alveolar collapse, pushes more oxygen across the alveolar membrane, and forces interstitial fluid back into the pulmonary circulation
Desired effect of the CPAP
Improve pulmonary compliance and make spontaneous ventilation easier for the patient
Many CPAP systems use ___ as the driving force to deliver positive ventilatory pressure
Oxygen
Some CPAP units can empty a D cylinder in ___
5 to 10 minutes
CPAP pressure relief valve determines ___
The amount of pressure the patient must breathe against and overcome
The amount of pressure the patient must breathe against and overcome
Expiratory positive airway pressure
EPAP
Expiratory positive airway pressure
CPAP EPAP setting typically ranges between ___
5 and 20 cm H2O
As a patient breathes against the EPAP, positive pressure is redirected to the ___
Lower airway
Patients benefit the most from CPAP during ___
Exhalation rather than inhalation
CPAP lowers the ___ of the heart
Cardiac output
CPAP is for ___
Patients experiencing respiratory distress in which their own compensatory mechanisms are not enough to keep up with the oxygen demand
General indications for using CPAP
- Patient is alert and able to follow commands
- Patient is displaying obvious signs of moderate to severe respiratory distress from an underlying pathology, such as pulmonary edema or obstructive pulmonary disease, or bronchospasm
- Respiratory distress occurs after a submersion incident
- Patient is breathing so rapidly that it affects overall minute volume
- Pulse oximeter reading is less than 90%
General contraindications for using CPAP
- Patient is in respiratory arrest or has agonal respirations
- Patient is hypoventilating
- Patient cannot speak
- Patient is unresponsive or otherwise unable to follow verbal commands
- Patient cannot protect their own airway
- Patient has hypotension
- Signs and symptoms of pneumothorax or chest trauma are present
- Patient has a tracheostomy
- Active gastrointestinal bleeding, nausea, or vomiting is present
- Patient has experienced facial trauma
- Patient is in cardiogenic shock
- Patient cannot sit upright
- CPAP system mask and strap cannot properly fit
- Patient cannot tolerate the mask
If CPAP is on a patient who deteriorates ___
Initiate positive-pressure ventilation with a bag-mask device attached to high-flow oxygen
CPAP units generally comprise a ___
- Generator
- Mask
- Circuit with corrugated tubing
- Bacteria filter
- One-way valve
The CPAP generator creates resistance that creates ___
Back pressure into the airways that pushes open the smaller airway structures as the patient exhales
CPAP pressure of __ is a generally acceptable therapeutic range
7.0 to 10.0 cm H2O
A typical CPAP unit will deplete a full D cylinder of oxygen in ___
15 to 30 minutes
The rate a CPAP oxygen bottle is depleted depends on ___
The fraction of inspired oxygen (FIO2) setting
Position for patient when using CPAP mask
High Fowler position
Valve to adjust CPAP
PEEP valve
PEEP valve
Positive end-expiratory pressure valve
The high pressure of the CPAP could cause a ___
Pneumothorax
A patient with a tracheostomy may have numerous holes in the neck, you should ignore any opening other than the ___
Midline tracheal stoma
If a patient has a tracheostomy tube, ventilate ___
Through the tube with a bag mask device and 100% oxygen attached directly to the device
If a patient has a stoma and no tube is in place ___
Use an infant or child mask to make a seal over the stoma, and seal the patient’s mouth and nose with one hand. Release the seal on the mouth and nose for exhalation
If you are unable to ventilate a patient with a stoma, try ___
Suctioning the stoma and the mouth with a French or soft-tip catheter before giving artificial ventilation through the mouth and nose
If you seal the stoma during ventilation via the nose or mouth, the ability to ___
Ventilate the patient may be improved, or it may help to clear any obstructions
An otherwise healthy child sho has supine difficulty breathing should be assumed to have ___
A foreign body airway obstruction
Difference between mild and severe airway obstruction
Severe completely blocks the airway
With good air exchange, the patient can ___
Cough forcefully, may hear wheezing
Production of whistling sounds during respiration
Wheezing
Wheezing is usually indicative of ___
A mild lower airway obstruction
With poor air exchange, the patient has ___
A weak, ineffective cough and may have increased difficulty breathing, stridor, and cyanosis
High-pitched noise heard primarily on inspiration
Stridor
Stridor is an indication of ___
A mild upper airway obstruction
For patients with a mild airway obstruction with poor air exchange, ___
Treat immediately as if there is a severe airway obstruction
Patients with a ___ are still able to exchange air but will have varying degrees of respiratory arrest
Mild airway obstruction
Patients with a ___ cannot breathe, talk, or cough
Severe airway obstruction
Most effective method to dislodge and force an object out of the airway of a conscious person
Abdominal thrusts
Use abdominal thrusts until __
The object dislodges or the patient becomes unconscious
For an unresponsive patient with severe foreign body airway obstruction, after the 30 compressions, perform ___
A tongue-jaw lift by grasping the jaw with your thumb and index finger. Place your thumb onto the tip of the patient’s lower teeth and tongue while placing your index finger under the body portion of the chin. Pull jaw/mouth open and look at the back of the oropharynx for foreign objects, and remove it if seen
Dental appliance that do not stay in place during ventilations should be ___
Removed
If dentures become dislodged ___
Place them in a container and transport them with the patient
Because blood supply to the face is so rich, injuries to the face can result in ___
Severe tissue swelling and bleeding into the airway
EMT role while ALS partner performs advanced airway intervention
- Help set up the procedure
- Perform BLS airway and ventilation maneuvers
- Help monitor the patient
The insertion of a tube into the trachea to maintain and protect the airway
Endotracheal (ET) intubation
The ET tube can be inserted through ___
The mouth or nose
The ET tube passes directly through the ___ and then into the ___
- Larynx between the vocal cords
- Trachea
First step in preparing a patient for ET intubation
Oxygenation
The process of providing oxygen, often in combination with ventilation, prior to intubation to raise the oxygen levels
Preoxygenation
A technique in which oxygen administered via a high-flow nasal cannula is left in place during an intubation
Apneic oxygenation
Visualization of the vocal cords with a laryngoscope
Direct laryngoscopy
Visualization of the vocal cords using a video camera and monitor
Video laryngoscopy
Intubation equipment sets include ___
- PPE
- Suction unit with rigid, tonsil-tip (Yankauer) and nonrigid, whistle-tip (French) catheters
- Laryngoscope handle and blade
- Magill forceps
- ET tube
- Stylette or tube introducer (Gum elastic bougie)
- Water-soluble lubricant
- 10-mL syringe
- Confirmation device, including waveform end-tidal CO2 monitors and/or colorimetric device
- Commercial ET tube securing device
- Alternate airway management devices
Six critical steps for ET intubation
B: perform Bag-mask pre oxygenation
E: Evaluate for airway difficulties
M: Manipulate the patient
A: Attempt first-pass intubation
GI: use a supraGlottic airway if unable to intubate
C: Confirm successful intubation/Correct any issues
Do not ___ the patient during the pre oxygenation phase of intubation
Hyperventilate
Ideal position for patient for intubation
Patient’s ear canal is on the same horizontal plane as their sternal notch
Patient’s ear canal is on the same horizontal plane as their sternal notch
Sniffing position
A cervical collar will need to be ___ before intubation typically
Undone
When the ALS provider is ready to begin the intubation attempt ___
Remove the oral airway and disconnect the mask from the bag in preparation for connecting the bag to the ET tube
When the ALS provider is attempting intubation, always keep ___ at hand
Mask and airway and suction equipment
A successfully intimated patient should have ___
End-tidal CO2 waveform, bilateral breath sounds present, and gastric (or epigastric) sounds absent
An intubated patient end-tidal CO2 waveform suddenly disappears is an indication of ___
The ET tube may have shifted out of the proper position
An intubated patient SpO2 levels begin to drop is an indication of ___
The ET tube may have shifted out of the proper position
ET tube is mistakenly placed in the esophagus rather than the trachea
Esophageal intubation
Esophageal intubation results in ___
Gastric distention as air is pumped into the stomach
An intubated patient has increasing resistance while ventilating indicates ___
Possible esophageal intubation
What to monitor with an intubated patient
- End-tidal CO2 level
- SpO2 level
- Ventilation resistance
- Physical signs of poor ventilation and perfusion
- Improper positioning or dislodgment of the ET tube
