Airway manoeuvres and devices Flashcards
What 3 areas make up the pharynx?
Nasopharynx
Laryngopharynx
Oropharynx
Where does the upper respiratory tract transition into the lower?
At the vocal cords
What is the cause of death in upper airway obstruction?
Hypoxia
2 accessory muscles that are used in a patient suffering upper airway obstruction?
Sternocleidomastoid
Scalene
What are some causes for upper airway obstruction? (there are lots)
Foreign body aspiration
CNS depression
Infection - laryngittis, epiglottitis, abscess,, haemorrhage, haematoma, laryngotracheobronchitis/croup
Laryngeal oedema - anaphylaxis, allergic, hereditory angioedema
PNS effects - Guillain Barre Syndrome, laryngospasm, obstructive sleep apnoea, right laryngeal nerve interruption
Neoplasm - pharyngeal, laryngeal, tracheobronchial carcinoma
Congenital - vascular rings, laryngeal web, laryngocele
Trauma
Burns
Most common cause of upper respiratory obstruction in the unconscious patient?
Loss of muscle tone
What is another name for the oropharyngeal airway adjunct and when can it be used?
Guidel
Used in unconscious or semi conscious as powerful gag reflex
How do you measure the right size of Guidel?
Corner of the mouth to angle of the jaw
What are the 3 colours of guidel and correlating sizes?
100mm = red 90mm = orange 80mm = green
When is a nasopharyngeal airway adjunct preferred over an oropharyngeal?
How do you measure sizing?
Semi-conscious patient as can be used with in tact gag reflex
Measure sizes from tip of the nose to the tragus of the ear
Contraindications to using the nasopharyngeal airway adjunct?
When there is a basal skull fracture
Any trauma
Active nose bleeds
What is an LMA and what are the advantages to using one over a bag valve mask?
Laryngeal mask airway
Sits over vocal cords
Allows free hand ventilation and less gastric distension
Accessory device for management of difficult airways
How do you calculate the volume required to inflate and LMA mask cuff?
Subtract 1 from the size and multiply by 10
What is the difference between the LMA and iGel?
What situation is it ideal for?
iGel doesnt have an inflatory cuff but instead a thermoplastic elastomer that seals around the larynx and hypopharynx at body temperature
Ideal for cardiopulmonary resuss
How does the iGel accomodate for gastric contents?
Small hole you can feed an NG tube down to drain gastric contents
Contraindications to using LMAs?
GORD, not fasted, obese, pregnancy, lesions of oropharynx, decreased lung compliance,
What sizes do iGel come in?
1-5
How should the iGel be sitting once it is in position?
In the upper oesophageal opening and cuff located against the laryngeal framework in the hypopharynx
Incisors resting on the integral bite block
What is an endotracheal tube?
Advanced airway protection that provides greater airway protection than the LMA or iGel
Why is the endotracheal tube considered the only safe form of intubation?
It bypasses the nose, larynx and pharynx to sit in the trachea just above the carina
completely protects against gastric content aspiration unlike LMA and iGel
No gastric aspiration, inflation, ensures patent airway
How do you know if you have accidentally caused oesophageal intubation with the endotracheal tube?
No capnography after a couple of breaths
Large air leak following cuff inflation
Hypoxia
How can you tell if you have performed endobronchial intubation accidentally with the ET tube? What damage can occur?
Tube inserted past carina into a main bronchus
Hypoxia, bronchospasm, high airway inflation pressure
Damage to single lung as pressures are too high
How is impaction combatted in ET tubes?
Murphy’s eye present on the tube allows air to escape even if impaction occurs
Impaction is when the tip of the tube abuts against the tracheal wall
What are 5 complications that can occur due to ET tubes?
Oesophageal intubation, endobronchial intubation, impaction, herniation, stretching of the tracheal wall
What is a bougie and what is it used for? What can you feel as you insert the bougie?
It is a long thin device used for difficult intubation
It is inserted so the ET tube can be fed over it
Acts as an introducer
Can feel tracheal clicks followed by a “hold up” sign
What things can Magills forceps be used for?
Guide NG tube down, guide tracheal tube through vocal cords, remove foreign bodies
What can suction equipment be used to remove?
Blood or secretions from pharynx
Stomach content via NG tube or orogastric tube
