chapter 7 - airway management and ventilation

Question 1

most common site of obstruction in unconscious patient?

Answer 1

pharynx

Question 2

causes of pharynx obstruction?

Answer 2

vomit
blood
trauma
foreign bodies

Question 3

causes of larynx obstruction?

Answer 3

excessive bronchial secretions 
mucosal oedema 
bronchospasm
pulmonary oedema 
aspiration of gastric contents

Question 4

clinical signs of airway obstruction?

Answer 4

inspiratory stridor - suggests obstruction at the laryngeal level or above
expiratory wheeze - obstruction in lower airways
gurgling
snoring

Question 5

what is a sign of a patient who has complete airway obstruction?

Answer 5

see-saw breathing - paradoxical chest and abdominal movement

Question 6

signs of choking?

Answer 6

patient unable to speak
unable to breath
sounds wheezy
attempts at coughing

Question 7

what should you do if a patient shows signs of mild airway obstruction in choking?

Answer 7

encourage cough

Question 8

what should you do if patient shows signs of severe airway obstruction in choking?

Answer 8

give 5 back blows
if that fails, give 5 abdominal thrusts
if still not relieved- continue alternating 5 back blows and 5 abdominal thrusts

Question 9

what should you do if a patient is unconscious following choking?

Answer 9

start CPR - chest compressions may dislodge the obstruction

airway trained personnel to undertake laryngoscopy and attempt to remove obstruction

Question 10

how are effective back blows given?

Answer 10

stand to the side and slightly behind the patient
support chest with one hand and lean patient forwards
give 5 sharp blows between the scapula with the heel of the other hand

Question 11

what size of nasopharyngeal airway is usually suitable for adults?

Answer 11

6-7mm

Question 12

what size I-gel is usually most appropriate for adults?

Answer 12

size 4

Question 13

steps to insert an I-gel?

Answer 13

lubricate the back, sides and front of I-gel
grasp firmly along the integral bite block
ensure patient is in “sniffing the morning air” position - head extended and neck flexed
gently press down on chin to open mouth
introduce the leading soft tip into the mouth
glide device downwards and backwards along the hard palate
look at the horizontal line at the middle of the integral bite block - this should be reached and will indicate approximately correct position

Question 14

what are the limitations of the I-gel

Answer 14

1) if there is high airway resistance (i.e. poor pulmonary compliance, pulmonary oedema, bronchospasm, COPD) there is a risk of significant leak around the cuff causing hypoventilation
2) uninterrupted chest compressions are likely to cause gas leak - if this happens, switch to 30:2
3) may cause coughing/choking if not deeply unconscious