Airway Mx And Adjunct Flashcards
Causes of airway obstruction
- tongue in unconscious pt (commonest)
- foreign body: vomitus, blood, teeth
- inflammation/infection: epiglottitis, croup, abscess
- tumours: polyps, larynx ca
Signs of airway obstruction
- stridor
- hoarseness
- dysphagia/drooling
- paradoxical see saw breathing
- use of accessory muscles
- intercostal/subcostal recession
- cyanosis
- decreased/absent breath sounds on lung auscultation
Mx of airway obstruction
Basic manouver
- head tilt chin lift
- jaw thrust
- orophryngeal or nasopharyngeal airway
- foreign body airway obstruction
Advanced airway
- supraglottic airway device (SAD) insertion
- endotracheal intubation
-cricothyroidotomy
- tracheostomy
Mx of airway obstruction
- antibiotics for infection (epiglotitis)
- nebulised adrenaline for airway edema
- nebulised budesonide for croup
- endoscopy/bronchoscopy to remove foreign body/aspirate from upper or lower airways
- surgical removal of polyps/tumours of airway
How to do head tilt chin lift
-hand is placed on pt forehead and firm backward pressure is applied
- this relieves minor obstruction
- with the other hand, chin is gently lifted to displace tongue anteriorly
How and when to do jaw thrust
- grab and lift angle of mandible upwards
- if mouth closed, push open with thumbs
- do in the presence or suspicion of cervical spine injury
How to confirm ETT placement (signs of successful seal and ventilation)
- direct visualization of ETT tip passing tru vocal cords
-foggy mask/water vapour in ETT - equal chest rise on manual ventilation
- breath sounds on auscultation (5 points: 2 infraclavicle, 2 inframammary, 1 epigastric)
- CXR
- return of/ end tidal co2 on exhalation capnography
Indications of ET tube
- inadequate oxygenation not corrected by oxygen mask
- inadequate ventilation
- to control & remove pulmonary secretions
- to protect airway in patients with depressed gag reflex eg; obtunded unconscious patients
- to secure airway eg burns, facial injuries
Essential equipment for ET
MMALESSSS)
M- mask with bag valve device (oxygen)
M- magills forceps
A- airways (oropharyngeal, nasopharyngeal)
L- laryngoscope
L- lubricant
E- endotracheal tubes
S- supraglotic airway device (SAD)
S- stylet/bougie
S- suction apparatus
S- stethoscope
S- syringe
S- securing tape/tie
Indication to use self inflating bag valve with face mask and example
Use in pt not breathing adequately or not breathing spontaneously
Examples: ambu bag, laerdal bag
Indication of oropharyngeal airway (OPA)
- prevents tongue from falling back
- for pt without gag reflex (unconscious): bcs if give in conscious pt, can induce retching and vomiting
Indication of nasopharyngeal airway
- better tolerated in pt with intact gag reflex
How to choose the right size of oropharyngeal and nasopharyngeal airway
Oropharyngeal: place the airway near the pt face with flange at the corner of mouth (midpoint of incisors) and tip of airway should end at the angle of mandible
Nasophrayngeal: place the flange of airway at the tip of nose and distal end of tragus of the ear
Types of laryngoscope blade
- miller (straight)
- macintosh (curved)
Size of ET tube
- women: 6.5-7.0
-men: 7.5-9.0 - children (1-10y): (age/4) + 4
Indication of SAD
-use in spontaneously breathing pt
- alternative to ET intubation
Function of ETT stylet
Maintain ETT curvature/shape during intubation
Airway assessment in ET tube
General
- obesity
- soft tissue swelling of neck
- large beard
- receding mandible
- small chin (micrognathia)
- limited range of movement of the cervical spine
Airway
- reduce mouth opening
- poor dentitian
- large tongue (macroglossia)
- deviation of trachea
- limited range of movement of the cervical spine
Bedside test to assess airway in ET intubation
- mallampati classification
- thyromental distance
- interincisor gap
- sternomental distance
Mallampati classification
Class 1: soft palate, whole uvula, tonsillar pillars
Class 2: soft palate, portion pf the uvula
Class 3: soft palate, base of uvula
Class 4: hard palate only
Thyromental & sternomemtal distance
- neck fully extended
- difficult intubation predicted if
Thyromental distance < 6cm
Sternomental distance < 12.5cm
Hyomental distance
Normal > 6cm (or > 3 finger breadth)
<4cm predicts difficult laryngoscopy
Definition of interincisor gap
- distance between with incisors with max mouth opening
- normal > 5cm (or >3 finger breadth)
<3cm predicts difficult laryngoscopy
<2cm predicts difficult SAD insertion
Placement of ET tube
Cormack Lehane (CL) score
- Full view of glottis and vocal cords
- Only part of vocal cords visible
- Only epiglottis visible
- No glottic structure visible (only tongue and/or soft palate seen)
