Clinical Management Of Airways Flashcards
what is the upper respiratory tract?
parts of the respiratory tract above the vocal cords
includes nasal cavity, oral cavity, nasopharynx, oropharynx, part of the laryngopharnx until vocal cords
what is the lower respiratory tract?
distal to the vocal cords: trachea, main bronchi, lobar bronchi, segmental bronchi, bronchioles, terminal bronchioles, alveoli
what is the conducting zone?
up to and including terminal brocnhioles
what epithelium lines the respiratory epithelium?
squamous epithelium for gas exchange
what epithelium lines the conducting zone?
made up of respiratory epithelium - ciliated pseudostratefied columnar epithelium with goblet cells
what makes up the respiratory zone?
respiratory bronchioles and alevoli
Your patient has swallowed some amalgam, which lobe will it likely head towards?
right main bronchus because it has a straighter angle than the left main bronchus.
what are the true and false vocal cords made of?
thryoarytenoid ligaments
why are vocal cords/glottis longer in males?
adams apple is more prominent
what are the causes of airway obstruction - within lumen?
within lumen - secretions, blood, foreign body, vomit
what are the causes of airway obstruction - luminal wall?
anaphylaxis, infection (and angio-oedema, laryngospasm, tumour, trauma)
what are the causes of airway obstruction - outside of the lumen?
oesophageal foreign body (and tumour, penetrating neck injury)
difference between stridor or wheeze?
signs of partial airway obstruction
stridor is more deep
what is the sign of complete airway obstruction?
no sounds
algorithm for assessing airway?
look, listen, feel - 10 second process
with severe airway obstruction you have an ineffective cough, how do you deal with this?
if unconscious start CPR
if conscious 5 black blows and 5 abdominal thrusts
with mild airway obstruction you have an effect cough, how do you deal with this?
encourage a cough
continue to check for deterioration to ineffective cough or relief from obstruction
advanced support ABCDE
airway, breathing, circulation, disability, exposure/everything else
airway managment procedure
- airway maneouvres
- adjuncts
- oxygenation/suction/ventilation
- alternative airway devices
- definitive airway
- mechanical ventilation
what are the airway maneouvres?
head tilt and lift - extension at the atlanto-occipital join and lifting of chin. simple effective and mobilises tongue from obstructing airway. not suitable for C-spine injuries.
jaw thrust - manual mandible protraction. pressure at angle of mandible. most successful when applied with head tilt.
what are adjuncts to airway management - oral?
oropharyngeal airway/Guedel:
measure from incisors to angle of jaw
better to oversize than undersize
lifts tongue off posterior pharynx
inserted ‘upside down’ as far as possible along the hard and soft palate, then rotate 180 degrees. poorly tolerated in those with present gag reflect.
what are adjuncts to airway management - nasal?
tolerated better than oropharyngeal airways. measured from tragus of ear to external nares. inserted bevelled end first towards septum. curvature pointing towards nasal floor.
when might nasal adjuncts be needed over oral adjuncts?
in clenched jaws, trismus, maxfax injuries
what is tracheal intubation?
optimal method. gives secure airway. trained individual airways only.
