Ch. 4: Management of the Airway Flashcards
What are the 6 main cause of upper airway obstruction?
- Tongue falling back against the posterior wall of
the pharynx, which is caused by unconsciousness or central nervous system (CNS) abnormality; patients with macroglossia (enlarged tongue) are at greater risk - Edema, or postextubation inflammation and swelling of the glottic area
- Bleeding
- Secretions
- Foreign substances
- Laryngospasm
List the 6 signs of partial upper airway obstruction
- Crowing, gasping sounds on inspiration (stridor)
- Inability to cough (with a slight obstruction, the
patient may be able to cough) - Increasing respiratory difficulty
- Good to poor air exchange (depending on the
severity of the obstruction) - Exaggerated chest and abdominal movement
- Cyanosis (depending on the severity of the obstruction)
List the 7 signs of complete upper airway obstruction
- Inability to talk
- Increased respiratory difficulty with no air
movement - Cyanosis
- Sternal, intercostal, and epigastric retractions
- Use of accessory muscles of the neck and chest
- Extreme panic
- Unconsciousness and respiratory arrest if obstruction is not removed
List the indications of an LMA (4)
a. Difficult face mask fit
b. Unsuccessful intubation and difficulty ventilating with bag mask
c. Unavailability of personnel trained in ET intubation
d. Elective surgical procedures
Contraindications of LMA (2)
a. Health care provider not trained in the use of the LMA
b. If risk of aspiration exists
Disadvantages of LMA (4)
a. Does not provide protection against aspiration
of gastric contents
b. Cannot be used if the mouth cannot be opened more than 0.6 inches (1.5 cm)
c. May not be effective when airway anatomy is abnormal
d. May be difficult to provide adequate ventilation if high airway pressures are required
During resuscitative procedures when cardiac output and blood pressure are low, gas exchange is reduced and the CO2 detector may read near 0, even when the ET tube is in the trachea.
KNOW THIS.
If the tube is inserted too far, it will enter the _______.
right mainstem bronchus
What is the average distance from the teeth to the carina for males and females?
27 cm in males and 25 cm in females
The carina is seen on radiographs at the __________ rib.
fourth rib or at the fourth thoracic vertebra
For ET tube extubation, when should you withdraw the tube?
At peak inspiration
What is the major clinical sign of glottic edema?
Inspiratory stridor
Never exceed _____ seconds per intubation attempt.
15-20
The blade and tube in the back of the throat may stimulate the vagus nerve, which may lead to bradycardia.
If the patient is conscious and has a partial airway obstruction, what should be done?
The patient should be monitored closely and allowed to try to relieve the obstruction on his or her own.
If the patient is conscious and has a complete airway obstruction caused by food or a foreign object, what must be done?
abdominal thrusts must be performed until the object is dislodged.
If the patient is unconscious and has a partial or complete airway obstruction that is most likely caused by the tongue, what can you do to help relieve the obstruction?
The head tilt and chin lift maneuver will help relieve the obstruction by moving the tongue forward.
The physician wants to begin weaning a patient from a tracheostomy tube. How can this best be accomplished?
Change to a fenestrated tracheostomy tube.
This airway maintains a patent airway by lying between the base of the tongue and the posterior wall of the pharynx, preventing the tongue from falling back and occluding the airway.
Oropharyngeal Airway
Explain why an oropharyngeal airway should only be used on unconcious patients.
A conscious patient would gag on the airway, potentially leading to aspiration.
Why should an oropharyngeal airway NEVER be taped in placed?
The airway must be easily removable to prevent vomiting and aspiration if the patient becomes conscious.
Proper insertion of the oropharyngeal airway
a. Measure the airway from the ________ to ensure proper length.
b. Remove foreign substances from the mouth.
c. Hyperextend the neck.
d.** Using the cross-finger technique, open the patient’s mouth, and insert the airway with the tip pointing toward the roof of the mouth.
e. Observe the airway passing the uvula, and rotate the airway _.
a. Measure the airway from the corner of the lip to the angle of the jaw to ensure proper length.
b. Remove foreign substances from the mouth.
c. Hyperextend the neck.
d. Using the cross-finger technique, open the patient’s mouth, and insert the airway with the tip pointing toward the roof of the mouth.
e. Observe the airway passing the uvula, and rotate the airway 180 degrees.
What are the hazards of the oropharyngeal airway? (4)
- Gag or fight the airway (Remove it immediately)
- If inserted wrong, the base of the tongue may be pushed back, obstructing the airway
- If airway is too large, epiglottis may be pushed into the larynegeal area
- If airway is too small, it may be aspirated or ineffective in relieving the obstruction.
What type of oropharyneal airway is made of hard plastic and have a groove down either side to guide a suction catheter to the glottic area?
Berman
What type of oropharyngeal airway is made of a soft, pliable material that has an opening through the middle to allow the passing of a suction catheter into the glottic area?
Guedel
This airway maintains a patent airway by lying between the base of the tongue and the posterior wall of the pharynx.
Nasopharyngeal airway
The nasopharyngeal airway is most commonly used to facilitate what?
Nasotracheal suctioning
List the hazards of nasopharyneal airways.
a. An airway that is too small may be aspirated.
b. Nasal irritation may result. To prevent nasal irritation, alternate nostrils daily.
This airway is tolerated by the conscious patient and still allows the patient to eat, drink, and speak.
Nasopharyngeal airway
How do you select the proper size of a nasopharygeal airway?
Select the proper size by measuring the airway from the tip of the nose to the earlobe. The outside diameter of the airway should be equal to the inside diameter of the patient’s internal nares.
When inserting a nasopharyngeal airway, the flanged end should rest against ________, and the distal tip should rest _________.
the nose, and the distal tip should rest behind the uvula.
When are LMA generally supposed to be used?
The LMA is designed to be used as an alternative to a face mask for achieving and maintaining control of the airway during surgery when tracheal intubation is not necessary, or in emergencies when ET intubation cannot be accomplished after several attempts.
True or false?
LMAs can be used in patients of all ages, from neonates to adults.
True
The LMA is inserted through the mouth and into the pharynx after being lubricated with a water- soluble gel. The device is advanced until _______.
resistance is met.
- Can be quickly inserted to provide ventilation
- Delivered VT may be greater than bag-mask ventilation
- Less gastric insufflation
- Ventilates equally as well a ET tube
- Simpler training
- No risk of esophageal or bronchial intubation
- Less risk of trauma
- Less coughing, sore throat, hoarseness and laryngospasm
Describe the insertion technique of the LMA
Using the index finger, advance the LMA until resistance is met. The cuff should be inflated until no leak is heard.
