AW Managment Flashcards
Reasons for altered AW patency
CNS depression from O.D. or anesthesia
Cardiac arrest
Loss of consciousness
Sleep apnea
Loss of consciousness diminishes what reflexes?
Gag
Swallow
Laryngeal
Tracheal
Carinal
Etiology of upper AW obstruction? (part or complete blockage)
Posterior tongue block
Foreign matter
Allergic reaction
Infection
Anatomical abnormalities
Trauma
How to assess AW patency?
Speak to patient if awake (they will indicate)
If not awake, lack of breathing sounds, or chest rise
First step to successfully resuscitation?
Skillful AW management
Gold standard of securing AW?
Endotracheal tube
Steps to head tilt/ chin lift?
Stand at side of patient
Place palm on forehead
Place fingers under bony part of chin
Tilt head backward using palm while lifting chin
What do you use if you suspect a spinal cord injury?
Modified Jaw Thrust
Indication for manual resuscitation
Apnea
Cardiac arrest
Impaired cough
Uncontrolled secretions
Increase O2 tension
To facilitate suctioning
Hyper inflate lungs
Need to transport unstable or intubated pt.
What do you do before bagging?
Pull out reservoir
Attach to source on at least 15L/min
Select best size mask
Attach mask to bag
Occlude patient side
Squeeze bag and feel for resistance
What happens if a NPA is too short?
Fails to separate soft palate from tongue
What happens if NPA is too long?
Can enter vallecula and become occluded by soft tissue
Esophagus
Enter larynx and stimulate cough reflex
Can stimulate gag and vomit
Process of insertion of NPA?
Measure NPA
Lubricant with water-soluble lubricant
Position patient in sniff
Introduce NPA with bevel toward nasal septum
Advance until airflow is established (start with right)
Retract AW if it meets resistance
Steps to insert an OPA?
Remove foreign matter
Hyper-extend neck
Open mouth with cross finger technique
Insert AW with tip aimed up
Aw should reach uvula
Rotate 180
Rest flange at top of lip
Tamps if necessary
Complications of OPA?
Iatrogenic trauma and AW hyperactivity
Minor trauma of pinching lips and tongue (common)
Ulceration and necrosis of oropharyngeal form long-term contact (days)
Volume of air ventilated?
400-500 cc
How often should you ventilate?
Every 5-6 seconds (10/minutes)
What should rescuers do during resuscitation?
Watch chest rise
Periodically auscultation to ensure adequate ventilation
What are other necessary measurements to obtain during bag mask ventilation?
Pulse oximetry and capnography
What is a suction tip called?
Yankauer
What are the four types of manual resuscitators?
Self-inflating bag/valve/mask
Flow Inflating
T-Piece
Automatic
Signs that determine need for an artificial airway?
Upper respiratory obstruction or infection
Neuromuscular disease (particularly in crisis)
CNS damage
Pulmonary failure
Cardiac failure or insufficiency
Signs that indicate use for a supraglottic Aw?
Maintain airway
Allows administration of gases
Permit manual or mechanical ventilation
Used in controlled or emergency when
intubation cannot be done
Blind insertion (orally)
Temporary airway
Examples of a supraglottic Aw?
Laryngeal mask airway
Laryngeal tube airway
Combitube
Indications for Laryngeal tube insertion
Blindly inserted for emergency AW management
Can be first choice or backup
Hazard of the supraglottic Aw
Aspirations with conscious and unconscious patients (awake may gag)
Hypoventilation
Oropharyngeal mucosal injury
Injury to larynx, esophagus and related structures
Esophagus disease (strictures, varices)
Abnormal anatomy
Displacement of glottis
Moving head can move tube
What is the magill curve
A curve in endotracheal tube to conform to anatomy of airway (12-16 cm)
Description of endotracheal tube
Wide bore conduit
Can be placed through nose
Made of PVC (thermoplastic) initially rigid but warms to BT and become softer for comfort (polymeric silicone can also be used)
Has a radio opaque line for x-ray placement
Specific ETT for specific procedures?
Oral surgery: RAE tube
Lung surgery: a double lumen tube
When do we use ETTs
Artificial airway
Bypass oral cavity and pharynx
When do we place nasotracheal tubes?
Awake patient
Poor visualization
Oral cavity
Mobilization of neck contraindicated
Impact of ETT diameter
Larger tubes have less Aw resistance (easier to suction pass bronchoscope)
Larger tube increases damage
Inner diameter decreases with time (can be critical at starts 24hrs after intubation)
Inner diameter of endotracheal tube?
Goes up by 0.5 mm (2.5-10mm)
Usual size of ETT by gender?
Females: 7-8 mm
Males: 8-9 mm
The four types of manual resuscitation?
The self-inflating bag/valve/mask
Flow inflating
T-piece
Automatic
Features on the BMV
Pressure relief bag w/ mechanisms to override
A pressure-sampling port to allow monitoring PIP
Exhalation valve has a splash guard (boops and secretions)
Exhalation valve can help deliver PEEP
Function of BMV
Smooth-bore oxygen tubing carries O2 from source
One-way valve at O2 inlet
When the bag is squeezed, one way valve near patient opens and near inlet closes
Fresh O2 flow is diverted to a tail at rear
Exhaled gas flows from mask out an additional one-way valve
BMV inner and outer diameter
A standard 15 mm internal diameter fits on endotracheal tube 22 mm external diameter slips in mask
Application for self-inflating BVM
Adult respiratory care
Medication installation
Aerosolized medication delivery
What influences the FiO2 delivery through a manual resuscitator?
Correct seal
O2 flow rate
Reservoir
BVM should deliver close to 100 FiO2
Stroke volume
Refill time
RR
When is breath delivered for the breathing patient?
When the pressure drop is felt/ pressure triggered
When is a breath delivered with the apeanic patient?
Time triggered (5-6 seconds)
Assessing appropriate breath delivery?
Chest rise
Look for condensation in mask
Listen for leaks
Watch for gastric distention
End-tidal CO2
Effects of poor bagging technique?
High RR age stroke volume can decrease venous return to heart
Pressure greater than 25cmH2O can cause gastric insufflation
If against spontaneous breaths can work against the patient
Trouble shooting BMV problems?
A substantial decrease in pressure to deflate bag can suggest O2 inlet valve failure
If patient cannot exhale, non-rebreathing valve may be broke or jammed
Sudden lose in resistance suggest pressure sampling port has popped open
Hazards of BVM?
Hypoxia
Equipment failure
Poor technique
Cross-contamination
Difficult or impossible to measure VT
Difficult or impossible to measure pressure
FiO2 can’t be measured
Contradictions for BVM
Awake intolerant patients
Untreated pneumothorax
Facial trauma
Total upper Aw obstruction
Should be guided by the type of Aw available and patient needs
cons of the Automatic resuscitators
Lacks consistency, sophistication in delivery, and alarm function
Can you set the maximum pressure for the O2 powered demand valve resuscitator
Yes
Is the Demand-valve resuscitation a one hand device
Allows two-handed mask seal
Reasons you wouldn’t perform resuscitators?
Patient had (do not intubate)
Resuscitation has been deemed to be futile
Resuscitation can be dangerous to rescuer
Does the flow inflating resuscitators non-rebreathing valve close during inspiration or expiration
Lack non-rebreathing mask
Coordinating tasks needed with flow inflating resuscitators
Adjust gas source
Control outflow resistance from bag through flow control valve to regulate CPAP
Control force of manual compression of the bag
Maintain proper seal
Application for flow inflating resuscitators?
Operating room
Delivery room
Neonatal intensive care
Not often with adults
T-piece resuscitator flow range
Compressed gas source delivers 5-15 L/m
Equipment for an intubation?
Laryngoscope
ETT
Stylet
Syringe
Suction catheter
CO2 detector
OPA
NPA
Bag-valve-mask
Nasal cannula
Laryngoscopes use?
Visualize larynx for diagnostic, procedure, therapeutic intervention
Most common: secure Aw
3 components: handle, blade, light source
Benefit of pen light /slender handle?
Improve balance for smaller blades
Benefit of the stubby handle?
Thicker and shorter for patients with thick necks or barrel chest
Benefits of large handles?
Used for larger patients
Benefits of adjustable handle?
Can be positioned for patients with cervical spine injury, halo traction, and obesity
Use for the Oxford blade?
Neonates, infantes, and children
Helps with cleft palate
Macintosh blade design?
Used for adults
Reverse “z” shape
Variety of flange styles:
Shape
Height
Light position
Light type
Miller usage?
Adults- infants with flexible Aw
Factors of hard intubation that video laryngeal scope is used for?
Restricted oropharyngeal
Blood/secretions in Aw
Cervical spine immobilization
Obesity
What is the lighted stylet used for?
Blind
Awake
Laryngo-scope assisted intubation
Lubricant light wand before
Design for the Bougie stylet?
Blunt ended malleable wand and twice the length of the ETT
(Contradicted by children less than 8)
What are tube exchangers?
Semi rigid tube with O2 hole
Marked by depth and used to exchange ETT without laryngoscope
Used when ETT fails
What flow does the demand valve deliver
Constant 30Lpm
How many mLs does the demand valve resuscitator deliver
500 mL
Is the RR automatically set on the demand valve resuscitator
No, it can be set or manually triggered by a button
How does the Demand-valve resuscitation device prevent GI distension
You can limit the pressure delivery
What were the flaws of the older Demand-valve resuscitation device
Many of them were reported for malfunctioning
Where is the Demand-valve resuscitation device used
Mostly military, rescue and EMS circumstance
Who strongly favors the Demand-valve resuscitation device
Emergency medicine physician
Diameter of the flow inflating resuscitators mask connector
Has 15 mm inner diameter and 22 mm outer
What feature of the flow inflating resuscitators that allows the RT to bag, assess
Designed in a 90 degree angle so RT can bag standing next to them or at head of bed
How does the flow inflating resuscitators flow control valve regulate flow
Flow control valve regulates resistance (NOT flow, source regulates)
What happens if the flow going to the bag isn’t great than the patients VT (flow inflating resuscitators)
The bag will collapse
What does the pressure manometer display
Peak inspiratory pressure
What does a Anesthesia bag do
Has a medication port for med delivery to tracheal airway ( if patient is intubated)
What feature does the flow inflating resuscitators have to prevent too much pressure reaching patient
Pressure pop off valve
What do experiences practitioners think about the mapleson bag
They find it sensitive to changes in patient compliance
Who mostly operates the mapleson bag
Anesthesiologist
(Properly trained practitioners)