Chapter 9 | Airway Management Flashcards
• Physiology of the airway • Pathophysiology of the airway • How to recognize an adequate or an inadequate airway • How to open an airway • How to use airway adjuncts • Principles and techniques of suctioning
Define:
airway
passageway by which air enters and leaves the body
Define:
patent airway
(PAY-tent)
an airway that is (and will continue to be) open and clear
Define:
glottic opening
level of the vocal cords that defines the boundary between the upper and lower airways
Fill in the blank:
For children, the mouth and nose are [BLANK] and [BLANK] than in adults.
the mouth and nose are smaller and more easily obstructed than in adults.
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For children, the tongue takes up [MORE/LESS] space proportionately in the mouth than in adults.
the tongue takes up more space proportionately in the mouth than in adults.
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For newborns and infants, nasal obstruction can impair breathing because [BLANK].
nasal obstruction can impair breathing because they typically breathe through their noses.
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When treating a choking child, remember that the trachea is [BLANK] and [BLANK] than adults.
remember that the trachea is softer and more flexible in infants and children.
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Because the trachea is narrower in children, it is also [BLANK].
it is also more easily obstructed by swelling or foreign objects.
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When performing CPR on children, remember that the chest wall is [BLANK] than adults.
remember that the chest wall is softer than adults.
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Infants and children tend to depend more on [BLANK] for breathing than adults.
Infants and children tend to depend more on their diaphragms for breathing than adults.
Define:
bronchoconstriction
contraction of smooth muscle that lines the bronchial passages
Explain:
complication of bronchoconstriction
decreased internal diameter of the airway resulting in increased resistance to airflow
List:
signs of partially obstructed airway
3 points
- inability to speak
- unusally raspy voice (hoarseness)
- unusual breathing sounds (stridor/snoring/gurgling)
Describe:
significance of stridor
(partially obstructed airway)
severely restricted air movement in the upper airway
(i.e. a child who swallowed a toy)
Describe:
significance of hoarseness
(partially obstructed airway)
restricted air movement in the upper airway
Define:
stridor
(partially obstructed airway)
variable and high-pitched respiratory sound
caused by blockage in windpipe (trachea)
Describe:
head-elevated and sniffing position
(maintaining an open airway)
preferred open-airway position for intubating patients
like sniffing flowers
List:
manual airway maneuvers
2 points (providing an airway)
- “head-tilt and chin-lift” maneuver
- “jaw-thrust” maneuver
Explain:
head-tilt and chin lift maneuver
(providing an airway)
- move body as a unit while keeping patient’s head, neck, and spine aligned
- kneel at top of patient’s head
- place one hand on forehead and fingertips of other hand under bony area at center of patient’s lower jaw
- tilt head by applying gentle pressure to patient’s forehead
- use fingers to lift chin and support lower jaw while moving jaw forward (lower teeth almost touching uper teeth)
- do not allow patient’s mouth to close
make sure you know where to put hands and how to make maneuver
Explain:
jaw-thrust maneuver
(providing an airway)
- move body as a unit while keeping patient’s head, neck, and spine aligned
- kneel at top of patient’s head
- place one hand on each side of patient’s lower jaw (below ears)
- use index fingers to push angles of patient’s lower jaw forward
- (if necessary) retract patient’s lower lip with thumb to keep mouth open
- do not tilt/rotate patient’s head
make sure you know where to put hands and how to make maneuver
List:
components of upper airway
3 points
- oral/nasal openings
- pharynx
- glottic opening
List:
components of lower airway
4 points
- glottic opening
- trachea
- bronchus
- lungs
List:
sources of airway obstructions
3 points
- foreign bodies: food or small toys
- liquids: blood or vomit
- swelling: infection, burns, or allergic reaction
List:
questions of airway assessment
2 points
- is airway open?
- will airway stay open?
Describe:
significance of rhonchi
snoring sound means airway blocked
often swallowed tongue
Describe:
significance of wheezing
medical problem (such as asthma)
Describe:
significance of gurgling/crackling
fluids (usually blood/vomit) in airway
treatment requires suction immediately
Describe:
significance of crowing
(harsh sound when inhaling)
medical problem that cannot be treated at scene
List:
signs of inadequate airway
4 points (airway that might not stay open)
- foreign bodies in airway
- no air felt/heard (air exchange below normal)
- absent/minimal chest movements
- abnormal breathing sounds
List:
characteristics of pediatric respiratory distress
3 points
- retractions
- nasal flaring
- anatomical differences (smaller mouth/nose, large tongue, or narrow/flexible trachea)
List (in order):
3 steps of airway management
- make it: open airway using appropriate maneuver
- check it: check for any sign of obstruction
- keep it: keep airway open
List:
special considerations of pediatric airways
3 points
- big heads
- big tongues
- small/weak tracheas
Define:
oropharyngeal airway (OPA)
airway adjunct used to move tongue forward as it curves back to pharynx
Explain:
how to size oropharyngeal airway
from corner of patient’s mouth to tip of earlobe
Define:
nasopharyngeal airway (NPA)
airway adjunct
soft and flexible tube inserted through nostril and into hypopharynx
Explain:
uses for nasopharyngeal airway
opening airway of patients with intact gag reflex or clenched jaw
Explain:
how to size nasopharyngeal airway
from patient’s nostril to tip of earlobe (or angle of jaw)
Explain:
how to insert nasopharyngeal airway
- lubricate outside of tube
- push tip of nose upward (keep head in neutral position)
- insert into nostril and advance until flange rests firmly against nostril
Fill in the blank:
Only use an OPA only on patients who [BLANK].
Only use an OPA only on patients who are not exhibiting gag reflex.
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When inserting OPA, take care not to [BLANK].
When inserting OPA, take care not to push the patient’s tongue into pharynx.
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When using airway adjuncts, always have [BLANK] ready.
always have suction ready.
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When using an OPA, do not continue inserting airway if [BLANK].
do not continue inserting airway if patient gags.
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When using airway adjuncts, [BLANK] the patient’s head position after insertion.
maintain the patient’s head position after insertion.
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When using airway adjuncts, be prepared to [BLANK] and [BLANK].
When using airway adjuncts, be prepared to remove adjunct and have suction ready.
Explain:
purpose of suctioning
obvious liquids (blood/secretions/vomit) must be removed from airway to prevent aspiration into lungs
List:
components of suction unit
4 points
- suction source
- collection container
- tubing
- suction tips or catheters
Define:
yankauer tip
(AKA “rigid pharyngeal suction tip” or “hard catheter”)
Define:
flexible suction catheter
catheter for when rigid tip cannot be used
not usually large enough to suction vomitus or thick secretions
Fill in the blank:
Suction no longer than [BLANK] seconds at a time.
Suction no longer than 10 seconds at a time.
Fill in the blank:
Prolonged suctioning can cause [BLANK] and [BLANK].
Prolonged suctioning can cause hypoxia and bradycardia.
Fill in the blank:
If a patient vomits for longer than 10 seconds while suctioning, [BLANK].
continue to suction.
Explain:
proper suctioning technique
3 points (and maximum duration)
- place tip or catheter where you want to begin suctioning (from back of mouth)
- suction only on the way out
- move catheter from side to side
no more than 10 seconds
Define:
rhonchi
sound of snoring made by the soft tissue of the upper airway creating impedance or partial obstruction to the flow of air
Answer:
What is the danger that an altered mental status can pose to a patient’s breathing?
can result in a loss of muscle tone and lead to collapse of the airway
Fill in the blank:
To be effective, a suction unit must be able to generate air flow of at least [BLANK] liters per minute and create a vacuum of no less than [BLANK] mmHg.
To be effective, a suction unit must be able to generate air flow of at least 30 liters per minute and create a vacuum of no less than 300 mmHg.
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The [BLANK] is the only reccommended airway procedure for an unconscious patient with possible head, neck, or spine injury or an unknown mechanism of injury.
The jaw-thrust maneuver is the only reccommended airway procedure for an unconscious patient with possible head, neck, or spine injury or an unknown mechanism of injury.
Answer:
When inserting an oropharyngeal airway, how many degrees do you need to rotate the airway so the tip is pointing down into the patient’s pharynx?
180º
Answer:
On arrival at the emergency scene, you find an adult female patient with gurgling sounds in the throat and inadequate breathing slowing to almost nothing.
How do you proceed to protect the airway?
patient needs immediate airway intervention (including suctioning, positioning, and potentially the insertion of an airway adjunct)
(if necessary) further treatment will include positive pressure ventilation and probably ALS assistance
Answer:
When evaluating a small child, you hear stridor. What does this sound tell you?
stridor indicates a partially obstructed upper airway
likely at the level of the glottis and epiglottis
Answer:
When evaluating a small child, you hear stridor, indicating a partially obstructed upper airway. What are your immediate concerns regarding this sound?
immediate concern is the threat of the airway occluding completely
rapid transport is necessary and ALS intercept if possible
Answer:
When assessing an unconscious patient, you note snoring respirations.
Should you be concerned with this? If so, what steps can you take to correct this situation?
snoring respirations indicate turbulent airflow through the partially occluded airway (often by the tongue)
(or injured/ill patients) snoring generally indicates a decreased capability to maintain the airway as consciousness decreases
corrective actions include positioning the head, opening the airway manually, and potentially inserting an airway adjunct
Fill in the blank:
Infants and children tend to breathe through their [BLANK].
Infants and children tend to breathe through their nose.
Define:
pulmonary edema
abnormal buildup of fluid in the lungs
Choose:
C
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B
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C
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B
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B
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B
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D
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D
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C
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D
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B
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A
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B
leaking clear fluid from ears or nose is usually cerebrospinal fluid
Choose:
D
avoid rotating patient’s head in case of c-spine injury
Choose:
B
jaw-thrust maneuver is used for suspected neck, head, or spinal trauma
Choose:
C
Choose:
C
yankauer tip is rigid device that has larger bore than most flexible catheters
not usually used with responsive patient (although certainly possible)
Define:
agonal breathing
agonal respirations
involuntary and insufficient respirations that are caused by hypoxia
a reflex to gasp for air
Answer:
What is the minimum acceptable pressure for an oxygen tank?
300psi
Describe:
range of oxygen flow rate for a nasal cannula
2-4 L/min
Describe:
oxygen flow rate for a non-rebreather mask
15 L/min
Describe:
oxygen flow rate for a BVM
15 L/min
Choose:
Which of the following interventions is contraindicated in patients with facial fractures?
A. Bag Valve Mask ventilation
B. Nasal cannula oxygen administration
C. Placing a peripheral IV
D. Placing nasopharyngeal airways
D
The only absolute contraindication listed here is the nasopharyngeal airway. There is a real risk of penetrating the meninges with nasal tube placement of any type when a facial fracture is present. Ventilation with a bag-mask and/or oxygenation with a nasal cannula are often complicating by significant facial trauma, but they are not contraindicated.
Choose:
You are dispatched for a 12-month-old choking on an unknown object. Dispatch informs you that the child is not breathing and is turning blue. When you arrive on scene the child’s mother is standing in the driveway holding the infant. The child is not breathing.
Which treatment is the most appropriate first treatment?
A. Follow current protocols to deliver oxygen
B. Follow current protocols to administer fluids
C. Follow current protocols to evaluate the airway
D. Follow current protocols to begin cardiopulmonary resuscitation
C
The best first step is to check the airway for obstruction and attempt to clear/open the airway. After this checking the pulse and beginning CPR if necessary are the next best steps.
Choose:
A school-age-child is choking in a school cafeteria. You come in to screams of “help!” and as you enter, the child goes unresponsive. In the BLS pediatric choking algorithm, which is the best thing to do first?
A. Begin delivering abdominal thrusts to clear the object from the airway.
B. Lay them on a flat, immovable surface and quickly check the throat for the object.
C. Start CPR immediately checking the airway before giving breaths.
D. Send a partner for the child’s parents.
C
It is assumed 911 has been called because you are there.
Since the child is now unresponsive, CPR is indicated. Checking the oropharynx for the object before giving breaths is indicated. If an object can clearly be seen, removing the object is then indicated.
Choose:
You are the first to arrive on scene of person found unresponsive but breathing adequately on his own. There is no obvious sign of trauma so you manually open the patient’s airway to allow adequate respirations until help arrives.
What is the best way to maintain an open airway of a non-trauma patient when airway adjuncts are not available?
A. Place them in the Trendelenburg position
B. Place them propped up in semi-fowler position
C. Place them in the left lateral recumbent position
D. Place them supine with body flat and head in neutral position
C
Placing a patient in the recovery or left lateral recumbent position gives gravity assistance to the clearance of physical obstruction of the airway by the tongue, and also gives a clear route by which fluid can drain from the airway. In the event that airway compromise develops, adding a chin lift or jaw thrust to this positioning can help keep the airway open.
