Chapter 9 Airway Management Flashcards
Patent
“Open and Clear Airway” &
“Will Remain Open and Clear”
Suctioning Define and facts
method of using a vacuum like device to remove such materials
- to be effective must furnish an air intake of at least
30 liters per min at open end
- when clamped it will generate a vacuum of no less then 300mmHg
- Suction no longer then 10 seconds*
Lower Airway
begins below Larynx and includes: Trachea, Bronchial Passages and alveoli
Preferred method for airway insertion for infant/child
Insert airway with tip already pointing down toward pharynx, using a tongue depressor to push tongue down and forward
*hook um
Head-tilt, chin-lift maneuver
A means of correcting blockage of the airway by the tongue by tilting the head back and lifting the chin.
- used when no trauma, or injury, is suspected
Two Ways to Open an Airway
Head-tilt, Chin lift, Jaw Thrust is a move that considers
C-spine precaution
Pediatric note on airway for Infants/Children
- Mouth/ nose smaller, easier to obstruct
- Tongue takes up more space in mouth then adults
- Trachea is softer more flexible / Narrower
- Chest wall is softer/ depend more on diaphragm for breathing
- Do Not HyperExtend neck when openings airway
- Be Gentle
- use rigid tip when suctioning
Rigid pharyngeal tip
(Yankauer)
Facts and cautions
Allows suction with excellent control
- larger bore
- must watch out for gag reflex when placed in pharynx
- also possible to stimulate “Vagus Nerve” in back of pharynx which can slow HR
Look, Listen, Feel
Method of assessment used to ensure that the airway is open and to assess future or occurring problems.
Used If a person is unconscious or alert
gag reflex
vomiting or retching that results when something is placed in the back of the pharynx. this is tied to the swallow reflex
Carina
Fork at the end of trachea leading into the bronchi
Special considerations in Airway Management
Facial injuries - may result in swelling or bleeding that may partially block airway
Obstructions - suction not adequate to take out solid objects: Abdominal Thrust, chest thrusts and finger sweeps are some manual techniques to clear airway manually
Dental Appliances - dentures should be left
but be prepared to remove it if it endangers airway
Adjuncts
Devices that aid in maintaining an open airway
Ex: OPA, NPA
Suction Catheters
More Flexible
- usually not large enough to suck Vommit or thick secretion
- sizes identified by “French” higher the number bigger the tube
Septum
Base of the nostril - wall that separates the nostrils
Oropharyngeal
OPA
A curved device inserted through the patients mouth into the pharynx to help maintain an open airway.
- Oral Airway
- Gently rotate 180 degrees so tip is facing downward.
- have suction ready prior to inserting any airway
- size by corner of mouth to earlobe
Bronchoconstriction
bronchospasm
Contraction of Smooth muscles that lines the bronchial passages that result in a Decreased Internal Diameter of the airway and Increased Resistance to Airflow.
Ex: Asthma or CPD
Difficulty Moving Air
Gasping, crowing,wheezing, snoring, and stridor
Retractions
Pulling of the muscles around clavicles and between/below ribs
Suctioning Techniques
- use appropriate PPE’s
- limit suctioning to less then 10 seconds
- put suctioning device where you want to begin and suction on the way out
Jaw-thrust maneuver
Maneuver to open airway by moving the jaw forward without tilting the head or neck.
- used when trauma or injury is suspected to the spinal cord or neck
- only recommended airway procedure for unconscious spinal injury is suspected
Best position to carry out artificial ventilation
Supine position, Always take C-spine Precautions
Sniffing Position
Bolt upright position, with head pitched forward as if they were trying to sniff something.
- in a person with a partially obstructed airway
Laryngopharynx
Hypopharynx
Structure surrounding the entrance to the trachea
- designed to provide structure to and protect the entrance to the trachea
Stridor
A high pitched sound generated from partially obstructed airflow in the upper airway.
Nasopharyngeal
NPA
A flexible breathing tube inserted through the patients nostrils into the pharynx to help maintain an open airway
- bevel should point toward base of nostril (septum)
- used when teeth or jaw is clenched or oral injuries
- lubricate outside of the tube w/ water based lube
- have suction ready prior to inserting any airway
*Note DO NOT use NPA if clear cerebrospinal fluid is coming out of nose or ears
What has priority: Airway or spinal injury?
Airway always has priority
Crossed finger technique
Method to open mouth
Cross the thumb and forefinger of one hand and place them on the upper and lower teeth at corner of mouth
NPA designed to go in which nostril
Right nostril is used for insertion
Suction unit consists of
- suction source
- collection container
- tubing
- and suction tips or catheters
Stridor indicates
- Upper airway obstruction
- Usually partially obstructed but very close to fully obstructed
- High pitched sound
- caused by foreign body, swelling of upper airway tissues or infection
Hoarseness indicates
- Voice changes Reflects upper airway narrowing
- happens when there swelling in airway from burn or allergic reaction
- development is often an ominous sign
Snoring indicates
- Sound of soft tissue of upper airway creating a partial obstruction
- common when sleeping
- in the case of injury may indicate AMS (altered mental status) by airway muscle tone being diminished
Gurgling indicates
Sound of fluid obstructing airway
- immediate sign to suction patient
