chapter 7 Flashcards
on which level is airway compromised the most ?
pharynx - at soft palate and epiglottis
what causes laryngeal obstruction ?
laryngeal edema = from burns inflammation , anaphylaxis
laryngeal spasm = foreign body
what will cause stridor ?
obstruction at laryngeal level
what will cause wheeze ?
obstruction of lower airways
complete airway obstruction clinical manifestation ?
see-saw breathing
paradoxical breathing
obstruction of tracheostomy management ?
remove foreign material from soma or tracheal tube
remove tracheal liner if there is one
try to pass suction catheter - perform tracheal suction and ventilate
if suction catheter will not pass remove the tracheostomy tube - seal the stoma and use bag valve mask
sequence of adult choking ?
signs of mild airway obstruction : encourage to continue coughing
severe :
support chest lean patient forward
5 sharp blows between scapula and heel of patient
and 5 abdominal thrust
if unconscious resus team
cpr may dislodge foreign body
laryngoscopy -removeforeign body with MAGILL’S FORCEPS
complication of oropharyngeal airway ?
vomiting or laryngospasm
what is used on patients partially conscious
nasopharyngeal airway
what type of airway is used in those with clenched jaw , truisms or maxillofacial injuries ?
nasopharyngeal airways
if there is basal skull fracture what type of airway management is preferred ?
oropharyngeal
side effects nasopharyngeal airways
cannot be measured through anatomical position of the face and mouth
6-7mm suitable in adults
insertion can cause damage to the mucosal lining of nasal airway - bleeding
if tube too long stimulations laryngeal or glossopharyngeal reflex - vomiting or laryngospasm
how is a rescuers expired oxygen ?
16-17 percent
what are the infections that can be transmitted upon CPR ?
TB and severe acute resp distress syndrome
COVID -19 - CONTRA FOR MOUTH TO MOUTH resus
disadvantages of bag mask ?
difficult to achieve gas tight seal
and maintain patent airway with one hand and squeeze the bag with the other
airway not patent - can go to the stomach - GASTRIC DISTENTION
2 PEOPLE ALWAYS PREFERRED- needs to be skilled = or in effective tidal volumes and cause gastric inflation with risk of regurgitation and pulmonary aspiration
how should two people work the bag mask
one person holds the face mask in place using jaw thrust with both hands and an assistant squeezes the bag
=OROPHARYNGEAL ALWAYS CONSIDERED WHEN USIN A MAG MASK VENTILATION
benefits of supraglotti airway ?
i-gel = faster insertion than most airway management
not much skills required
gastric inflation minimised
regurgitation minimised and aspiration very rare
ALWAYS PREFERED O BAG MASK VENTILATION
can be inserted through chest compressions
how to put I-gel supraglottic airway ?
APPROPRIATE SIZE I-GEL - size 4 in most adults
lubricate the back , sides and front of i gel cuff
ensure patient in sniffing the morning air position - head extended , neck flexed and gently press the chin down
glide device downwards and backwards along the HARD PALATE
if resistance = jaw thrust and slightly rotate device
CORRECT POSITION - TIP AT UPPER ESOPHAGEAL opening
cuff located at larynx
incisors resting at bite block
disadvantages of i gel - supraglottic airway
in presence of high air resistance and poor pulmonary compliance = pulmonary edema , COPD , bronchospasm
= risk of leak around cuff = causing hypoventilation =
what is done of tracheal intubation has failed and BAG VALVE MASK ventilation is impossible ?
LMA - laryngeal mask airway
SUPRA GLOTTIC AIRWAYS
benefits of tracheal intubation ?
trial and research has shown no significant advantage of one airway management over the other
patent airway protected from aspiration of gastric contents, or blood from oropharynx
provide adequate tidal volume through cpr
free rescuer hands
suck out air way secretions
DISADVANTAGE OF TRACHEAL TUBE INTUBATION
CPR INTERRUPTIONS - brief paise in cpr - only when passing vocal cords
so defer this until ROSC
needs real skilled people
in which cases can laryngoscopy and attempted intubation be life threatening and impossible and causes deterioration
acute epiglottitid
pharyngeal and laryngeal disse
head injury
cervical spine injury
= needs aesthetic drugs , video laryngoscopy , flexible fibreoptic laryngoscopy
with airway management how to know
