Mod D Tech 16 16 Airway Management Flashcards
Airway management must be
Airway management must be rapid and effective.
Stepwise airway management employs a series of increasingly complicated manoeuvres to open and maintain the airway, used in stepwise order; the simplest, quickest and least invasive first.
Name Manual methods of Airway Control
- Recovery position
- •Head tilt / Chin lift
- •Trauma chin lift
- •Trauma jaw thrust
- •Suction / manual clearance
recovery Postion
Head Tilt/Chin Lift
Jaw thrust
Airway Adjuncts inc.
What does SAD stand for
name devicies
Supraglottic Airway Devices (SAD)
- Oropharyngeal Airway
- Nasopharyngeal Airway
- •Laryngeal Mask Airway
- I-Gel
Indications for the
use of an OPA
•To maintain a patent (open) airway by preventing the tongue from covering the epiglottis which could prevent the patient from breathing
•
•As a person becomes unconscious, the muscles in their jaw relax and allow the tongue to obstruct the airway
Sizing an OPA
Inserting an OPA
•Open patient’s airway using cross finger technique
•
- Insert ‘upside down’ (curved end along the roof of the mouth) and using the hard palate as a guide, advance until tip approaches back of the mouth
- Rotate 180 degrees and continue to insert until the flange comes to rest at the teeth
Paediatrics OPA
•In children – insert the ‘right way up’ – why do you think this is?
•
Anatomical differences:
Larger tongue
Narrower airways – more easily obstructed
Longer floppy epiglottis
Larger occiput
Complications/Hazards for OPA
- Vomiting
- •Can worsen airway obstruction – if placed incorrectly can depress tongue into the back of the pharynx, further blocking the airway
- Can cause trauma to the mouth – injury to hard or soft palate (tearing, bleeding etc)
- Can cause pharyngeal stimulation with coughing or vomiting
- •Laryngospasm
Contraindications
- In patients with a cough or gag reflex
- •Clenched teeth / trismus
- •Oral trauma
- •Conscious or semi-conscious patient
Important points
•Clear mouth and pharynx before insertion
•
•Withdraw if patient rejects insertion
•
•Check that air is passing through it once inserted
•
•Maintain careful observation to ensure the lumen stays clear
Nasopharyngeal
Airways (NP airway)
Nasopharyngeal Airways
NP airways are to be used when an OPA will not be tolerated such as in the following circumstances:
- Fitting or seizures
- Suspected cervical spine injury
- Awake or semi-conscious state
- Active gag reflex
- Trismus
Contra-indications N.P. airways must not be used in
N.P. airways must not be used in:
- Patients with nasal injury
- •Cases of recurrent nose bleeds or nasal polyps
- •Children < 12 years
Caution
N.P. airways
Base of skull # indicators
Possible Complications NPs
- Nasal bleeding
- •Laryngospasm and vomiting
- •Ineffective airway
Measuring an NPA
Nasopharyngeal airway insertion
- Oxygenate the patient
- •Select and lubricate the airway
- •Position patient in “sniffing the morning air” position
- Lubricate, gently insert into patients largest nostril (Usually right) perpendicularly
- Slide with slight twisting motion into nostril until flange sits against opening
Reassess
- Airway adequate
- •Breathing adequate
- •Suction as appropriate
- •Oxygen via non re-breathing mask
- •Monitor the patient constantly
IGEL Indications for use ?
Contraindications ?
- Stepwise airway approach
- •Securing and maintaining a patent airway in emergency situations
- •Personnel should be suitably trained and experienced in the use of airway management techniques
- •Paediatric use in extreme circumstances when all other methods have failed
Contraindications
- Trismus
- •Active gag reflex
- Limited mouth opening
- Trauma or mass
Removal IGEL
Do not attempt to forcibly remove the device if the patient is biting on it.
Wait until the patient, on vocal command, has fully opened their mouth or opens it spontaneously
Suction Equipment
•There are many different types of suction equipment in use within the Ambulance Service
•
- The operating principle for all is the same.
- The equipment creates a vacuum within the apparatus and a catheter then aspirates substances into a container
Suction Types of Catheter
When to use Suction
- Regurgitation in the unconscious patient
- •Excessive sputum
- Blood from:
- Maxillo facial injury
- Head injury
- Epistaxis
abdominal haemorrhage
•Saliva in patients who have difficulty in swallowing due to:
- Cerebral haemorrhage
- Oesophageal obstruction
- Injuries to the pharynx
- •Clearance of oropharyngeal airway
Failing to use Suction could lead to
- Airway obstruction
- •Stomach contents entering the lungs
- •Pneumonia
- •Lung collapse
Use of Suction Equipment and Catheters
- Store flexible catheters so they do not kink
- •Use only sterile catheters – Do not remove from packet until needed
- Insert catheter first, then switch on the suction unit
- •Do not touch the end of the catheter that will be inserted into the patient’s mouth
Use of Suction Equipment
and Catheters
•Gently rotate the catheter backwards and forwards to prevent it adhering to soft tissue
•
- After use, suck clean water through the catheter
- •Suction should only be applied for a few seconds at a time
General points:
- Reduce the pressure for children
- •Do not allow the reservoir to overfill
- •When using suction on a poisoned casualty, retain a sample for analysis
