Chapter 8 Airway Management Flashcards
Patent Airway
an airway that is open and clear and will remain open and clear, without interference to the passage of air into and out of the body.
airway
the passageway by which air enters or leaves the body. The structures of the airway are the nose, mouth, pharynx, larynx, trachea, bronchi, and lungs.
Bronchoconstriction
the contraction of smooth muscle that lines the bronchial passages that results in a decreased internal diameter of the airway and increased resistance to air flow.
Stridor
a high pitched sound generated from partially obstructed air flow in the upper airway
Head-tilt, Chin-lift maneuver
a means of correcting blockage of the airway by the tongue by tilting the head back and tilting the chin. Used when no trauma, or injury is suspected.
- Once the patient is supine, place one hand on the forehead and place the fingertips of the other hand under the bony area at the center of the patient’s lower jaw.
- Tilt the head by applying gentle pressure to the patient’s forehead.
- Use your fingertips to lift the chin and to support the lower jaw. Move the jaw forward to a point where the lower teeth are almost touching the upper teeth. Do not compress the soft tissues under the lower jaw, which can obstruct the airway.
- Do not allow the patient’s mouth to be closed. To provide an adequate opening at the mouth, you may need to use the thumb of the hand supporting the chin to pull back the patient’s lower lip. Do not insert your thumb into the patient’s mouth (to avoid being bitten).
Jaw-thrust maneuver
a means of correcting blockage of the airway by moving the jaw forward without tilting the head or neck. Used when trauma, or injury is suspected to open the airway without causing further injury to the spinal cord in the neck.
- Carefully keep the patient’s head, neck and spine aligned, moving him as a unit as you place him in the supine position.
- Kneel at the top of the patient’s head. For long-term comfort it may be helpful to rest you elbows on the same surface as the patient’s head.
- Carefully reach forward and gently place one hand on each side of the patient’s lower jaw, at the angles of the jaw below the ears.
- Stabilize the patient’s head with your forearms.
- Using your index fingers, push the angles of the patient’s lower jaw forward.
- You may need to retract the patients lower lip with your thumb to keep the mouth open.
- Do not tilt or rotate the patients head.
Oropharyngeal airway OPA
a curved device inserted through the patient’s mouth into the pharynx to help maintain an open airway.
- Place the patient on his back and use an appropriate manual method to open the airway. If no spinal injuries are suspected, use a head-tilt, chin-lift maneuver. If there are possible spinal injuries, use the jaw-thrust maneuver, moving the patient no more than necessary to ensure an open airway (the airway takes priority over the spine).
- Perform a crossed-finger technique to open he mouth. That is, cross the thumb and forefinger of one hand and place them on the upper and lower teeth at the corner of the patient’s mouth. Spread your fingers apart to open the patient’s jaws.
- Position the airway device so that it’s tip is pointing toward the roof of the patient’s mouth.
- Insert the device and slide it along the roof of the patient’s mouth, past the soft tissue hanging down from the back (the uvula), or until you meet resistance against the soft palate.Be certain not to push the patient’s tongue back into the pharynx. Any airway insertion is made easier by using a tongue blade (tongue depressor) or a rigid suction tip to assist in moving the tongue forward. In a few cases, you may have to use a tongue blade to hold the tongue in place. Watch what you’re doing when inserting the airway. The procedure should not be performed by “feel” only.
- Gently rotate the airway 180 degrees so that the tip is pointing down into the patient’s pharynx. this method prevents pushing the tongue back. Alternatively, insert the airway with the tip already pointing “down” toward the patient’s pharynx, using a tongue depressor a rigid suction tip to press the tongue down and forward to avoid obstructing the airway. This i the preferred method for airway insertion in an infant or child.
- Position the patient. Place the non trauma patient in a head-tilt position. If there are possible spine injuries, maintain cervical stabilization at all times during airway management.
- Check to see that the flange of the airway is against the patient’s lips. If the airway device is too long or too short, remove it and replace it with the correct size.
- Monitor the patient closely. If there is a gag reflex, remove the airway adjunct at once by following the anatomical curvature. You do not need to rotate the device when removing it.
Nasopharyngeal airway NPA
a flexible breathing tube inserted through the patient’s nose into the pharynx to help maintain an open airway.
- Measure the nasopharyngeal airway from the patient’s nostril to the ip of the earlobe or to the angle of the jaw. Choosing the correct length will ensure an appropriate diameter.
- Lubricate the outside of the tube with a water-based lubricant. Do not use a petroleum jelly or any other type of non-water based lubricant. Such substances can damage the tissue lining of the nasal cavity and the pharynx and increase the risk of infection.
- Gently push the tip of the nose upward. Keep the patient’s head in a neutral position. Most of the nasopharyngeal airways are designed to be placed in the right nostril. The bevel(angled portion at the tip) should point toward the base of the nostril or toward the septum (wall that separates the nostrils).
- Insert the airway into the nostril. Gently advance the airway until the flange rests firmly against the patient’s nostril. Never force a nasopharyngeal airway. If you experience difficulty advancing the airway, pull the tube out and try the other nostril.
Gag reflex
vomiting or retching that results when something is placed in the back of the pharynx. This is tied to the swallow reflex.
Suctioning
use of a vacuum device to remove blood, vomitus and other secretion of foreign materials from the airway.
Signs of an Inadequate Airway
- There are no signs of breathing or air movement.
- There is evidence of foreign bodies in the airway including blood, vomit, or objects like broken teeth.
- No air can be felt or heard at the nose or mouth, or the amount of air exchanged is below normal.
- The patient is unable to speak, or has difficulty speaking.
- The patient has an unusual hoarse or raspy quality to his voice.
- Chest movements are absent, minimal, or uneven.
- Movement associated with breathing is limited to the abdomen (abdominal breathing)
- Breath sounds are diminished or absent
- Noises such as wheezing, crowing, stridor, snoring, gurgling, or gasping are heard during breathing.
- In children, there may be reactions (a pulling in of muscles) above the clavicles and between and below the ribs.
- Nasal flaring (widening of the nostrils of the nose with respirations) may be present, especially in infants and children.
Rules for Using Airway Adjuncts
-Open the patient’s airway manually before using an adjunct device.
-When inserting the airway, take care not to push the patient’s tongue into the pharynx.
-Have a suction ready prior to inserting an airway.
-Do not continue inserting the airway if the patient begins to gag. Continue to maintain the airway manually and do not use an adjunct device. If the patient remains unconscious for a prolonged time, you may later attempt to insert an airway to determine if the gag reflex is still present.
-When an airway adjunct is in place, you must maintain the head-tilt, chin-lift or jaw-thrust maneuver and monitor the airway.
-After an airway adjunct is in place, continue to be ready to provide suction if the gag reflex returns.
-If the patient regains consciousness or develops a gag reflex, remove the airway immediately.
Use infection control practices while maintaining the airway.Wear disposable gloves. In airway maintenance, there is a chance of a patients body fluids coming in contact with your face and eyes. Wear a mask and goggles or other protective eyewear to prevent this contact.
Tubing, Tips and Catherters
- Tubing
- Suction tips
- Suction catheters
- Collection container
- Container of clean or sterile water
