Airway part I Flashcards
Airway evaluation
If airway is:
- Critical- do immediate intervention
- OK or mildly compromised- no real hurry
- Moderately compromised- consider intervention, but must also monitor very closely
Airway management
Least invasive to most
Cont’d observation, O2, pulse oximeter, ECG
Pt re-positioning, airway devices, jaw thrust
LMA, other devices
Endotracheal intubation
Tracheotomy or cricothyrotomy
How to assess pt airway
Quick observation: resp effort/apnea, air moving, cyanosis, retraction, dyspnea, air hunger, resp. rate, obtunded, M-S weakness Acute obstruction (blood, vomitus, secretions, foreign body, trauma); or hx of chronic airway or pulm condition (pt normally impaired) Auscultation: wheeze, rales, rhonchi, stridor, air movement
What does the lemon law stand for?
Look externally Examine (3-3-2) Mallampati grade Obstruction (Obesity) Neck mobility
Air hunger
Dyspnea with great discomfort
Retrognathia
Jaw is behind
Nearly impossible to do standard intubation
3-3-2 rule
Assess oral opening- 3 fingers
Measure the mandible- 3 fingers
Position of larynx- 2 fingers
Assessing the oral opening
Should be able to accommodate 3 fingers
Measuring the mandible
Should be able to fit 3 fingers between the mentum and the hyoid bone
Assessing the position of the larynx
Should get 2 fingers between the thyroid cartilage and the mandible
Do not extend head all the way when using this rule
Mallampati classification
Ranges from classes I-IV
Class I is most patent, IV is most obstructed
III- only top part of uvula is seen
Class I- can see hard palate, soft palate, uvula, pillar
What are causes of obstruction?
Obstruction can result from both external compression or internal blockage (foreign body, tumor, etc.)
Stridor
A high-pitched, harsh sound occurring during inspiration
It is a sign of upper airway obstruction
May be caused by laryngospasm, epiglottitis, foreign body, aspiration, airway trauma
Neck mobility
Not every pt will come in with neck brace, must ask pt about neck
Intubation requires neck extension
Airway management caveats
First, do no harm
Get help and monitor pt
Continue to observe during tx efforts
Less invasive is safest- don’t over-treat
Pt directives and informed consent: DNI or DNR should be followed
If algorithms or pathways are available, follow them, but-
1st branch of algorithm tree is more impt: obstructed airway (crisis) or lung problem
3 big indications for E-T intubation
Pt’s inability to maintain and protect patent (open, unobstructed) airway
Failure/insufficiency of oxygenation or ventilation
Anticipated need that is based on clinical course or tx requirements- airway, pulmonary, cardiac, neurologic, sepsis/shock, pending surgery with general anesthesia
Who are the airway experts?
Anesthesiologists EMTs Intensivists/pulmonologists ICU/CCU/ER staff Resp therapists
Why to defer to the airway experts
They have more experience with, and are better at:
- The airway evaluation
- Use of less invasive devices (nasal/oral airways)
- LMA devices, laryngoscopes
- Have access to expensive non-standard equipment
- Better able to recognize/anticipate complications
Where does airway obstruction most commonly occur?
Above epiglottis, at oropharynx; the tongue and/or soft palate touch posterior pharyngeal wall which occludes airway (as in sleep apnea)
Why jaw thrust works
What airway devices are available?
Ambu bag and mask Oral airways Nasal airways LMAs Oral tubes (combitube, King device) E-T tubes Crico-thyrotomy devices Tracheotomy
Nasal airway
Also called “nasal trumpet” due to shape
Made of latex or silastic; different sizes
Should always be lubricated before insertion (and warm)
Many pts have deviated septum- don’t force
LMA
Used a lot in anesthesia, more comfortable than NG tube
Doesn’t seal off airway- don’t use in conscious pts
