Mgmt of airway and breathing Flashcards
what are top A and B priorities
patent airway and ventilation
what is main goal of A and B
O2 in and CO2 out
what is first question
is airway patent
4 parts of normal airway
- mouth/nose
- oro/nasopharynx
- larynx/glottis
- trach
3 possibilities when assessing airway patency
- unobstructed
- partial obs
- complete obs
what are signs of each obs
- patient talking - patent
- noisy breathing or gurgling - partial
- no breathing - complete obs
what does hoarseness mean
vocal cords affected
- can worsen rapidly, so need to beware
3 ways to recognize obstuction
look - resp effort - chest rising - indrawing listen - noisy breathing - voice feel - for air via mouth and nose
4 ways to manage an obst
- sution - remove debris
- jaw thrust/chin lift - pulls mandible and tongue forward
- oroph/nasopha airway - pushes and keeps tongue forward
- laryngeal mask airway
what to do if these don’t work
laryngeal mask airway (LMA)
what is LMA
- provides patent airway, but not protection from aspiration
- not a defninitve airway
what is goal once patency is acheived
protect from aspiration as well
- definitive airway
what is definitive airway
endotracheal tube
what does ETT do (3)
- patent airway
- protection
- able to deliver gas by pressure to lungs
3 places and ETT can be inserted
Above cords - ETT Below cords - cricothyroidotomy - tracheostomy
5 indications for a def. airway
- patency
- protection
- O2
- ventilation
- pulm. toilet
6 steps to intubation of a normal patient
- sniffing pos.
- 100% O2
- anasthetic meds
- ventilate
- intubate
- confirm correct placement of ETT
6 ways to confirm airway is in the trachea
- visualize with a scope
- exhaled CO2 (gold standard)
- chest rising
- equal A/E
- condensation on tube
- bronchoscopy
when to use CXR
AP does not confirm in thachea
- can be useful to see the position once you know it’s in
7 things that are special in trauma PT for airways
- emergent/urgent
- altered LOC/ not cooperative
- full stomach
- possible C-spine
- facial and airway traumas
- hypovolemic
- hypo oxemic
how to manage C-spine
- assume it is damaged
- keep in a neutral position all the time
3 levels of breathing
- adequate
- not at all
- breathing but not adequate
2 aspects to assessment of breathing
- act/mechanics of breathing
2. diffusion of O2 and CO2 in alveoli
3 ways to assess breathing
look - rate/distress - tidal vol - symettry listen - to lungs feel - chest wall
3 things to do if breathing aquately
- apply O2 mask
- apply o2 sat monitor
- monitor
3 things to do if not breathing
- esure patency of airway
- ventilate
- figure out why apneaic
3 things to do if patient not breathnig adequately
- vent. of not adequate TV
- intubate if not enough o2/COs
- determine etiology
5 locations that could cause inadequate ventilation
- brainstem
- cord
- chest wall
- pleura
- lungs