EAC Airway Management and Airway Adjuncts

Question 1

Causes of airway obstruction

Answer 1

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

Question 2

how to recognise airway obstruction

Answer 2

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

Question 3

signs and symptoms of:

Foreign Body Airway Obstruction FBAO

Answer 3

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

Question 4

Signs of FBAO

Answer 4

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.

Question 5

Adult choking management:

Mild airway obstruction

Answer 5

encourage to cough. check for deterioration to ineffective cough or relief of obstruction

Question 6

Adult choking management:

Severe airway obstruction (conscious)

Answer 6

5 back blows
followed by
5 abdo thrusts
repeat until airway clear or until Unconscious

Question 7

Adult choking management:

Severe airway obstruction (unconscious)

Answer 7

Start CPR

Question 8

how to perform:

Back Blows

Answer 8

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

Question 9

how to perform:

Abdo Thrusts

Answer 9

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.

Question 10

manual methods of airway control

Answer 10

Lateral position
Head Tilt Chin Lift
Jaw Thrust
Triple Airway Manoeuvre

Question 11

how to perform:

Lateral position

Answer 11

all patients with altered level of consciousness should be transported in this position.

turn the patient onto their right side.

Question 12

how to perform:

Head Tilt Chin Lift

Answer 12

palm of hand on forehead pushing down

use other hand under chin to assist tilting head backwards

Question 13

how to perform:

Jaw Thrust

Answer 13

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

Question 14

how to perform:

Triple Airway Manoeuvre

Answer 14

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.

Question 15

how to perform:

Infant Back Blows

Answer 15

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

Question 16

Purpose of Oropharyngeal Airway OPA

Answer 16

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.

Question 17

hazards and limitations of:

Oropharyngeal Airway OPA

Answer 17

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

Question 18

sizes of:

Oropharyngeal Airway OPA

Answer 18

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

Question 19

method for measuring pt for:

Oropharyngeal Airway OPA

Answer 19

measure form level with the mid-incisor to the angle of the jaw

Question 20

technique for inserting:

Oropharyngeal Airway OPA

Answer 20

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.

Question 21

considerations inserting:

Oropharyngeal Airway OPA

Answer 21

clear the mouth and pharynx before inserting

any resistance, coughing or gagging remove OPA and reassess

Question 22

Indications for use of:

Naso-Pharyngeal Airway NPA

Answer 22

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

Question 23

contra-indications of:

Naso-Pharyngeal Airway NPA

Answer 23

bilaterally obstructed or deformed nasal passages

nasal injury

recurrent nosebleeds

nasal polyps

Question 24

hazards and limitations of:

Naso-Pharyngeal Airway NPA

Answer 24

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

Question 25

sizes of:

Naso-Pharyngeal Airway NPA

Answer 25

6mm

7mm

Question 26

technique for inserting:

Naso-Pharyngeal Airway NPA

Answer 26

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

Question 27

maximal adjunct use involves

Answer 27

an OPA and two NPA’s

Question 28

protocol for choking infants and children

Answer 28

back blows

NO abdo thrusts