Airway & Ventilation Flashcards
Causes of airway problems:
- Blockage in airway - FB, blood, vomitus, secretions
- Infection & oedema - direct trauma, epiglottitis
- Narrowing airway - laryngospasm, bronchospasm
- CNS depression - head injury, hypercapnia, metabolic (hypoglycaemia), drugs (alcohol, opioids, GA)
If a patient is unconscious, the commonest cause of airway obstruction is:
- Soft palate obstructing the passage of oxygen
How to check for airway problems:
1. Look
2. Listen
3. Feel
Checking for airway problems - Look - What to look for?
- Chest & abdominal movement
Checking for airway problems - Look - How does normal breathing look?
- Chest expands outwards
- Abdomen expands outwards
Checking for airway problems - Look - How does obstructed breathing look?
- Chest tries to expand
- Abdomen pulled inwards
- See Saw breathing
- Use of accessory muscles
Checking for airway problems - Listen - What to listen for?
- Listen to breathing
Checking for airway problems - Listen - What does normal breathing sound like?
- Quiet
Checking for airway problems - Listen - What does partial obstruction sound like?
- Noisy - snoring, wheezing, gurgling, stridor
Checking for airway problems - Listen - What does complete obstruction sound like?
- Silence
- No air flowing in or out
Checking for airway problems - Feel - What to feel for?
- Feel for airflow at the mouth and nose.
What to do when an airway obstruction is recognised?
- Airway manoeuvres to relieve obstruction
What are the manoeuvres for relieving airway obstruction?
1. Head tilt
2. Chin lift
3. Jaw thrust
Manoeuvres for relieving airway obstruction - How to perform Head Tilt?
- Place one hand on the pt’s forehead
- Tilt the head back gently.
Manoeuvres for relieving airway obstruction - How to perform Chin Lift?
- Place the fingertips of other hand under the point of the chin
- Gently lift upwards to stretch the ant. neck structures
- Look, listen & feel again to see if the obstruction is resolved
Manoeuvres for relieving airway obstruction - How to perform Jaw Thrust?
- Identify the angle of the mandible.
- Place your index & other fingers behind the angle of the mandible & lift upward
- Keep the mouth slightly open
- Recheck to see if there are any signs of airway obstruction
Types of simple airway adjuncts:
- OP airway
- NP airway
Where are oropharyngeal airways are designed to fit & how do they work?
- Fit - Between the tongue & hard palate
- Work - Hold the tongue out of the way.
What if OP airway used in semi-conscious patient?
- Could provoke vomiting
- Or laryngospasm
When can NP airway be used?
- In patients who are not deeply unconscious
- Better tolerated than OP airways
When to be cautious of using NP airway?
- Suspected base of skull fracture
Which patients require ventilatory support?
- Pt’s with no or poor respiratory effort
How to perform BMV?
- Best performed with 2 people
- 1 person holds the face mask + performs jaw thrust
- Other person squeezes the bag 10 times/min
Matt is 62 years old and has been brought into the Emergency Department with a suspected head injury; his c-spine has been cleared. He is now unresponsive on the ACVPU scale. You use an ABCDE approach to assess Matt.
How do you initially assess his airway?
- Look, listen and feel for signs of airway obstruction
Which of the following signs indicate that Matt has an obstructed airway?
Seesaw movements/ snoring sounds/ quiet breath sounds/ he is unconscious
- See saw movements of the abdomen
- Snoring sounds
Matt is showing signs of airway obstruction. You are concerned that due to his low conscious level the soft tissues of his palate are obstructing airflow.
Which of the following steps are most appropriate?
Call for help/ Apply high flow O2 via NRBM/Perform jaw thrust/ All of the above
- All of the above should be carried out.
Pt. with an obstructed airway - always call for help as the pt. could deteriorate very quickly.
High-flow oxygen via a NRBM - ensures the pt. receives a high concentration of O2. This prolong the amount of time until the pt. desaturates.
Jaw thrust - lifting the soft tissues that are obstructing airflow.
You call for help, perform a jaw thrust and apply high-flow oxygen. However, the signs of airway obstruction are still present.
What else should you do?
Raise O2 level/ Insert OP airway/ Ventilate pt. with self-inflating bag/ wait for help
- Insert OP airway
An OP airway would be an appropriate airway adjunct. You are already delivering high-flow O2 to the pt.; this cannot be increased further.
The pt. needs the obstruction to be relieved so that the O2 can reach the lungs. Currently the pt. is making adequate respiratory effort & does not require ventilation using a self-inflating bag.
Help has now arrived but after inserting the oropharyngeal airway, you notice that Matt’s chest is no longer rising, and he is not breathing. You check for signs of life and confirm he is in cardiac arrest. A cardiac arrest call has gone out; chest compressions are commenced, and the defibrillator is attached.
How do you now manage Matt’s airway?
Leave the oropharyngeal airwav and oxygen mask in place/ Remove the oropharyngeal airway and ventilate with a self-inflating bag/ Leave the oropharyngeal airway in place & ventilate with a self-inflating bag using a 2-person technique/ Leave the oropharyngeal airway in place & ventilate with a self-inflating bag using
- Leave the OP airway in place & ventilate with a self-inflating bag using a 2-person technique
Matt is in cardiac arrest and is therefore not making any respiratory effort; he needs ventilating.
Leaving the O2 mask in place would not provide ventilation.
The OP airway should be left in place as it helps to overcome any airway obstruction.
The best technique for ventilating with a self-inflating bag is a 2-person technique as it means you can achieve a better seal with the face mask.
General signs of choking:
- Occurs while eating
- Pt. may clutch neck
Chocking - signs of mild airway obstruction:
- Able to speak
- Able to cough
- Able to breathe
Chocking - signs of severe airway obstruction:
- Can’t speak
- Can’t breathe
- Breathing sounds wheezy
- May only respond by nodding
- Coughing attempts are silent
- Pt. may be unconscious
Adult choking guidelines:
Choking - How to give back blows:
- Stand slightly behind pt.
- Support chest w/ 1 hand
- Lean pt. well forwards
- Give 5 sharp blows between scapulae
- W/ heel of other hand
- If fails - move to abdominal thrusts
Choking - How to give abdominal thrusts:
- Stand behind pt.
- Put both arms around upper part of their abdomen
- Place clenched fist just under xiphisternum
- Place other hand on top of clenched fist
- Pull sharply inwards & upwards
- Repeat 5 times
- Alternate between back slaps & abdominal thrusts
How to estimate size of OP airway?
- Measure length from pt’s incisors
- To angle of the jaw
Sizes of OP airways:
- Small - size 2 - ISO 8.0
- Medium - size 3 - ISO 9.0
- Large - size 4 - ISO 10.0
How to insert OP airway?
- Open pt’s mouth
- Introduce airway past teeth in “upside-down” position
- Then rotate through 180 °
- Pass airway beyond hard palate into oropharynx
Suitable size of NP airway for adults:
- 6-7 mm
How to insert NP airway?
- Lubricate airway
- Insert airway bevel end first
- Vertically along floor of nose w/ slight twisting action
- Try R. nostril 1st
- If obstruction, try L. nostril 2nd
Size of i-gel:
- Most adults:
- Small females:
- Tall males
- Most adults - size 4
- Small females - size 3
- Tall males - size 5
How to insert i-gel?
- Lubricate all sides
- Pt. in sniffing position - neck flexed, head extended
- Press down on chin to open mouth
- Introduce soft tip into mouth in direction towards hard palate
- Glide downwards & backwards along hard palate
- Push until resistance felt
- Tip - located at upper oesophageal opening
- Cuff - located against larynx
- Incisors - resting on bite-block
- Horizontal black line - level of the teeth
Limitations of i-gel:
- Risk of significant leak - if high airway resistance / poor lung compliance
- Leak - uninterrupted chest compressions
- Risk aspiration of stomach content
- Coughing, laryngeal spasm - pt. not deeply unconscious
