EAC Airway Management and Airway Adjuncts Flashcards
Causes of airway obstruction
Tongue
Foreign Material in the throat
- blood, vomit, saliva
- FBAO (dentures, food, small objects)
Laryngeal spasm and oedema
Fractured Larynx
Lower respiratory obstruction
- aspiration of blood, gastric contents, other fluids
- excessive bronchial secretions
- pulmonary haemorrhage
how to recognise airway obstruction
Look: in mouth and for chest or abdominal movement
Listen: for air passing in and out of mouth and/or nose
Feel: for air passing out of mouth and/or nose
signs and symptoms of:
Foreign Body Airway Obstruction FBAO
Difficulty breathing and speaking
Attempts to move any obstruction by coughing
Use of accessory muscles
Abnormal breathing sounds or none at all
Obvious signs of choking or distress
Cyanosis
Restlessness, confusion, agitation and disorientation
Unconsciousness
Signs of FBAO
Universal distress signal for choking
Vigorous attempts to try to dislodge obstruction by coughing
Mild airway obstruction: answers “yes” to the question are you choking. able to speak, cough and breathe
Severe airway obstruction: unable to speak, may nod to the question “are you choking”. cyanosis. abnormal breath sounds. attempts at coughing may be silent. Unconscious. Death.
Adult choking management:
Mild airway obstruction
encourage to cough. check for deterioration to ineffective cough or relief of obstruction
Adult choking management:
Severe airway obstruction (conscious)
5 back blows
followed by
5 abdo thrusts
repeat until airway clear or until Unconscious
Adult choking management:
Severe airway obstruction (unconscious)
Start CPR
how to perform:
Back Blows
stand to the side and slightly behind the patient.
Support the patients chest with one hand and lean them well forwards.
Give a sharp blow between the scapulae with the heel of the other hand
how to perform:
Abdo Thrusts
Stand behind the patient and put both arms around the upper part of the abdomen.
clench your fist and grasp it with the other hand.
Pull sharply inwards and upwards in one rapid movement.
manual methods of airway control
Lateral position
Head Tilt Chin Lift
Jaw Thrust
Triple Airway Manoeuvre
how to perform:
Lateral position
all patients with altered level of consciousness should be transported in this position.
turn the patient onto their right side.
how to perform:
Head Tilt Chin Lift
palm of hand on forehead pushing down
use other hand under chin to assist tilting head backwards
how to perform:
Jaw Thrust
hold mouth open by downward movement of the chin with thumbs
using index fingers apply steady pressure upwards and forwards at the angles of the mandible to lift it upwards and forwards
how to perform:
Triple Airway Manoeuvre
a combination of head tilt chin lift and jaw thrust
performed in a similar way to jaw thrust, except traction of the head is maintained using the heels of the hands.
how to perform:
Infant Back Blows
produces an instant decrease of pressure in the patients airway
hold infant in prone position with their chest resting in the palm of one hand with torso on forearm
give up to five sharp back blows between the scapulae with the heel of one hand
Purpose of Oropharyngeal Airway OPA
to keep the tongue off the back of the throat for those pt’s who are unconscious and unable to maintain their own airway alone.
To make it easier for you to use oropharyngeal suction.
To keep the lips and teeth slightly apart to maintain an open airway.
hazards and limitations of:
Oropharyngeal Airway OPA
Not a perfect size for everyone.
Too small an OPA may push tongue onto the pharynx
Too large OPA may end in hypo-pharynx and increase risk of passive regurgitation and air flow into the stomach.
May stimulate the pt’s gag reflex causing:
- vomiting, further compromising the airway
- Vagal stimulation
sizes of:
Oropharyngeal Airway OPA
paramedic only:
00= infants/babies
0= babies/toddlers
1= toddlers/children
EAC: 2= children 7-11yrs 3= children/small adults >10yrs 4= adults 5= large adults
method for measuring pt for:
Oropharyngeal Airway OPA
measure form level with the mid-incisor to the angle of the jaw
technique for inserting:
Oropharyngeal Airway OPA
Hold by flanged end
Open pt’s mouth and slide inverted OPA over tongue
Mid way in rotate the OPA 180 degrees and advance it behind the tongue
advance the OPA until it sits within the mouth, with the flange outside the teeth.
considerations inserting:
Oropharyngeal Airway OPA
clear the mouth and pharynx before inserting
any resistance, coughing or gagging remove OPA and reassess
Indications for use of:
Naso-Pharyngeal Airway NPA
aged over 12
presenting with upper airway obstruction due to backward displacement of tongue
pt’s with clenched jaw, seizures, jaw fractures, awkward/loose teeth
contra-indications of:
Naso-Pharyngeal Airway NPA
bilaterally obstructed or deformed nasal passages
nasal injury
recurrent nosebleeds
nasal polyps
hazards and limitations of:
Naso-Pharyngeal Airway NPA
severe nasal haemorrhage
damage to mucous membrane, bone, cartilage
possible inadvertent passage into cranial cavity through fractured cribriform plate
provocation of wretching, vomiting, laryngeal spasm
sizes of:
Naso-Pharyngeal Airway NPA
6mm
7mm
technique for inserting:
Naso-Pharyngeal Airway NPA
select smallest size first
lubricate tube with aqua-gel
introduce into right nostril, directing the tube backwards inline with the hard palate, not upwards
insert using a slight side to side rotation and gentle pressure until inserted fully. flange flush with nose.
check for unimpeded air flow through tube and the pt is tolerating it
administer oxygen and assist ventilation as necessary
maximal adjunct use involves
an OPA and two NPA’s
protocol for choking infants and children
back blows
NO abdo thrusts