Airway, Ventilation And the i-gel Flashcards
Define ventilation
Act of inhaling and exhaling
Define oxygenation
The addition of oxygen to the blood stream
What will happen if a patient is being oxygenated but ventilation is inadequate?
Respiratory acidosis, CO2 levels will rise and pH will drop
How can we measure ventilation?
Check respiratory rate and effort as well as measuring end-tidal CO2
What is the first thing we must consider before attempting to ventilate a patient?
Is the airway patent? What interventions may be necessary to manage the airway?
Name the methods and equipment used to manage an airway
- manual manoeuvres e.g. head tilt chin lift, jaw thrust
- OPA / NPA
- i-gel (superglottic airway device)
- endotracheal intubation
When is it appropriate to escalate airway management to the use of an I-gel?
When both manual manoeuvres and OPA and NPAs aren’t working to manage the patient’s airway
Summarise the I-gel OSCE
- Position patient and place OPA
- Start ventilations with BVM rate of 12/minute or one ventilation every 5 seconds - connect airway circuit, attach O2 tank and turn it on to 15L, connect catheter mount, filter and end-tidal CO2
- Estimate patients weight to choose correct size of I-gel
- Lubricate cuff
- Open patients mouth, check airway is clear, place tip of I-gel against hard palette
- Glide against roof of mouth into airway until definitive resistance met
- Reconnect the airway circuit, catheter mount attaches to top of the I-gel (ideally less than 30 second gap between last ventilation before I-gel was inserted and first ventilation after)
- Confirm i-gel in situ with end-tidal CO2 and auscultation
- Secure I-gel in place
What are the benefits of an I-gel?
- create better seal
- less likely to cause gastric insufflation
- avoid risk of hyperventilation
- frees up hands
How many attempts to fit an I-gel are acceptable before other airway adjuncts must be considered / used?
No more than three attempts
What does ETCO2 (end-tidal CO2) measure?
Expired (exhaled) carbon dioxide - good indicator of ventilation
What is a normal ETCO2 reading?
Between 4.0 - 5.7 kPa (kilopascals)
What two types of readings can you get when measuring ETCO2?
Capnometry (gives a number) and capnography (gives a graph / waveform)
What devices can you use to measure ETCO2?
- mainstream devices e.g. EMMA
- side stream devices e.g. …
- nasal probe with end-tidal CO2 monitor
What is the start line in a ETCO2 reading called?
Respiratory base line
What is the part of a wave form that spikes up called?
Expiratory upstroke
What is the horizontal line called that is found after the expiratory upstroke on a wave form?
Alveolar plateau
What is the downward line called that is found after the alveolar plateau on a wave form?
Inspiratory downstroke
Where in the wave form is the ETCO2 measurement taken?
The point between the alveolar plateau and the inspiratory downstroke (highest point of the wave)
What does a bronchospasm wave form pattern look like?
Shark fin (short expiratory upstroke (often found in asthmatic patients)
Why might a patients ETCO2 be low?
- reduced cellular metabolism
- circulatory issues
- issues with the respiratory system
What must you do if the ETCO2 reading is low?
Slow down ventilation rate
What must you do if the ETCO2 reading is low during assisted ventilation?
Slow down ventilation rate
What should you do in the ETCO2 reading is high during assisted ventilation?
Speed up (supply) ventilation rate
