Chapter 7 Airway managment and ventilation Flashcards
Name the likely location of airway obstruction if you heard the following: Snoring Gurgling Inspiratory stridor Expiratory strictor
Partial obstruction of pharynx by tongue of palate
Liquids in upper airways
Obstruction above laryngeal inlet
Obstruction below laryngeal inlet
What is a head tilt chin lift?
Forehead tilted back, chin lifted up
Stretches anterior neck structures
What is a head tilt chin lift?
Forehead tilted back, chin lifted up
Stretches anterior neck structures
What maneuver can you add to a jaw thrust to make it move effective?
Head tilt
You need to give bag-valve-mask ventilation, the patient has dentures. Do you leave them in or take them out?
If loose - remove them
If well fitting - keep them in
Can you still do airway manouvers (head tilt, chin lift, jaw thust) with a naso/oropharyngeal airway in-situ?
Yes, they may still be needed and can help
A patient is between sizes for an oropharyngleal airway. Do you choose size up or down?
Up. Slightly too large is better than slightly too small.
Name 3 complications of an oropharyngeal airway
Displace tongue backwards
Lodge in the vallecula
Push epiglottis into lumen of airway
What can happen if you try to insert on oropharyngeal airway into a conscious patient?
Stimulate vomiting or laryngospasm
What is the risk of the nasopharyngeal tube is too long?
Stimulate vomiting, laryngospas
What are the benefits of a fine-bore flexible suction catheter over a wide-bore rigid sucker (Yankauer)?
Useful in patients with limited mouth opening.
Can be used to suction through an orpharygneal or nasopharyngeal airway
What increases the risk of gastric inflation?
Malignancy of head and neck, obstructed airway
Incompetent eosophageal sphincter (present in all cardiac arrest patients)
High inflation pressure/volumes
When bagging a patient during CPR, over what time should be breath be given over?
1 second
If too slow, inspiratory time will be prolonged and time available to give good chest compressions is reduced
If you hyperventilate a patient, this will lead to increased intrathoracic pressure. Why is this a problem during CPR?
Reduces coronary perfusion
When a bag-valve-mark has oxygen attached, what oxygen levels are achieve 1)without an O2 reservoir bag, 2) with an O2 reservoir bag
1) 45%
2) 85% (same as non-rebreather)
You are a single operator and are proving manual ventilating with a BVM but has a poor seal. To compensate you give excessive compression of the bag. What is the risk with this?
High peak pressures
Forces more air into the stomach
What are some trouble-shooting techniques if insertion of an LMA is proving difficult?
Ensure head in sniffing position
Push tip of LMA posteriorly with fingers
Ask assistant to apply jaw thrust
Give a slight 45 degree twist
You insert an LMA. There is good chest rise and fall but a small airleak. Is this acceptable or do you need to reposition?
Acceptable. Leave as is
What is the seal pressure of an LMA?
Standard - 20mmHg
I-Gel 20 - 25mmHg
Beyond this air will leak out (mostly into mouth, some into stomach).
What can happen if you apply cricoid pressure during active vomiting?
Eosophageal rupture
While circoid pressure can help prevent gastric aspiration, there are complications that make its routine use not supported during CPR. What are they?
Impairs ventilation in many
Complete airway obstruction in up to 50%
When applying cricoid pressure, how much pressure should be used? What are you trying to achieve?
3kg or 30N
Compresses eosophagus against vertebral column
When using a bougie with very poor or blind technique, how do you know you are in the airway vs eosphagus?
Airway: feel for click of tracheal rings, bougie advancement will be stopped by smaller airways of bronchial tree
Eosophagus: no clicking of tracheal ring, can be inserted FULLY (passes into stomach)
