Chapter 9: Airway Management Flashcards
Airway
the passageway by which air enters and leaves the body
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
Pharynx
Throat; divides into 3 regions:
- oropharynx
- nasopharynx
- laryngopharynx
Oropharynx
where the oral cavity joins the pharynx
Nasopharynx
where the nasal passages empty into the pharynx
laryngopharynx
the structures surrounding the entrance to the trachea
Glottic opening
entry point to the larynx
epiglottis
- protective flap that sits above the glottic opening designed to seal off the trachea during swallowing or in response to the gag reflex
- leaf like structure; protected by vocal cords
What is protected by 16 rings of cartilage?
Trachea
Cricoid ring
a complete circle of cartilage; forms the lower aspect of the larynx and provides structure to the superior trachea
Airway Obstructions
Tongue, blood, vomit, secretions, food, small toys
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 airflow; common in asthma
How can you determine the presence of an airway in most patients?
By saying ‘hello’
Stridor
a high-pitched sound generated from partially obstructed airflow in the upper airway
“Sniffing position”
a bolt upright position with their head pitched forward as if they were attempting to smell something; indicates airway obstruction from sniffing (infection, allergic reaction, etc.)
Look-Listen-Feel Method
Look at the chest for rise and fall
Listen at the mouth for sounds of breathing
Feel the chest for movement
Signs of an inadequate airway
- no signs of breathing or air movement
- evidence of foreign bodies in the airway (blood, vomit, or objects such as broken teeth
- no air can be felt or heard at the nose or mouth, or the amount of air exchanged is below normal
- the pt is unable to speak or has difficulty speaking
- the pt has an unusual hoarse or raspy quality to their voice
- chest movements are absent, minimal, or uneven
- movement associated with breathing is limited to the abdomen
- 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 retractions above the clavicles and between and below the ribs
- nasal flaring may be present, especially in infants and children
Hoarseness
Indicates swelling around the vocal cords
Snoring
indicates a decrease in mental status such that airway muscle tone is diminished
Gurgling
indicates fluid obstruction of the airway
Head-tilt chin-lift
Used when no trauma, or injury is suspected
- Once the pt 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 pt’s lower jaw
- Tilt the head by applying gentle pressure to the pt’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 pt’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 pt’s lower lip. Do not insert your thumb into the pt’s mouth (to avoid being bitten).
Jaw-thrust maneuver
Most commonly used to open the airway of an unconscious pt w/ suspected head, neck, or spine injury or unknown mechanism of injury
- Carefully keep the pt’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 pt’s head. For long-term comfort, it may be helpful to rest your elbows on the same surface as the pt’s head
- Carefully reach forward and gently place one hand on each side of the pt’s lower jaw, at the angles of the jaw below the ears
- Stabilize the pt’s head with your forearms
- Using your index fingers, push the angles of the pt’s lower jaw forward
- You may need to retract the pt’s lower lip with yor thumb to keep the mouth open
- Do not tilt or rotate the pt’s head
Two most common airway adjuncts
oropharyngeal airway & nasopharyngeal airway
What is the main function of the OPA & NPA?
To keep the tongue from blocking the airway
Oropharyngeal airway (OPA)
- a curved device inserted through the mouth into the pharynx to help maintain an open airway
- no gag reflex (unconscious pt)
Nasopharyngeal airway (NPA)
- a flexible breathing tube inserted through the pt’s nostril into the pharynx to help maintain an open airway
- alert pt w/ gag reflex, clenched teeth/oral injury
How to measure for what size OPA to use
- measure the device from the corner of the pt’s mouth to the tip of the earlobe on the same side of the pt’s
- an alternative way is to measure from the center of the pt’s mouth to the angle of the lower jawbone
Inserting an oropharyngeal airway (OPA)
- Ensure the OPA is the correct size by measuring
- Use the crossed-fingers to open the pt’s mouth
- Insert the airway with the tip pointing to the roof of the pt’s mouth
- Rotate it 180 degrees into position. When the airway is properly positioned, the flange rests against the pt’s mouth
- After proper ventilation, the pt is ready for ventilation
Inserting a nasopharyngeal airway (NPA)
- Measure the NPA to make sure it is the correct size for the pt
- Apply a water-based lubricant before insertion
- Gently push the tip of the nose upward, and insert the airway with the beveled side toward the base of the nostril or toward the septum. Insert the airway, advancing it until the flange rests against the nostril
When not to insert an NPA
if clear (cerebrospinal) fluid is coming from the nose or ears; may indicate a skull fracture where the airway would pass
Suctioning
method of using a vacuum device to remove blood, vomit, and other secretions or foreign materials from the airway
Mounted Suction Systems
- mounted systems, often called on-board units, create a suctioning vacuum produced by the engines manifold or an electrical power source
- furnish air intake of at least 30 liter per minute w/ vacuum of 300 mm Hg
Portable Suction Units
- may be oxygen, air, or electrical powered
- must provide 30 liters per minute, 300 mm Hg
Suction equipment
tubing, suction tips, suction catheters, collection container, container of clean or sterile water
Suction tip
- most popular is rigid pharyngeal tip/Yankauer/tonsil sucker/tonsil-tip suction
- allows you to suction the mouth and pharynx with excellent control over the distal end of the device
Suction catheters
- flexible plastic tubes
- come in various sizes identified by a number “French”; the larger the #, the larger the catheter
- usually not large enough to suction thick secretions or vomit
Suctioning Techniques
- Turn the unit on, attach a catheter, and test for suction at the beginning of your shift
- Position yourself at the pt’s head and turn the pt’s head or entire body to the side
- Open and clear the pt’s mouth
- Place the convex side of the rigid tip against the roof of the mouth. Insert just to the base of the tongue
- Apply suction only after the rigid tip is in place. Do not lose sight of the tip while suctioning. Suction while withdrawing the tip.
- If you are using a flexible catheter, measure it from the pt’s earlobe to the corner of the mouth or from the center of the mouth to the angle of the jaw.
How is suction best delivered?
With the pt on their side; allows gravity to assist suction as free secretions will flow from the mouth while suctioning is being delivered.
How to position pt’s for suctioning w/ suspected neck or spine injuries?
- if pt is fully immobilized, the entire backboard may be tilted to place the pt on his side
- if pt is not immobilized, suction the best you can without turning the pt
Special considerations in airway management
facial injuries, obstructions, dental appliances
Whose airway is more easily occluded?
CHILDREN
