S4C28 - Noninvasive Airway Management Flashcards
Anatomy
- larynx superiorly is upper airway
- trachea inferiorly is lower airway
How to determine if pt is protecting the airway:
- if spontaneous swallowing is not present then they are at risk for aspiration
- initiate airway mgmt if any concern about airway patency, oxygenation or ventilation
Laryngospasm
- closure of glottis by constriction of intrinsic/extrinsic laryngeal muscles
- can occlude ventilation
- triggers: stimulation of upper airway receptors on tongue, palate, oropharynx, blood, vomitus, water
- hypoxia and hypercapnia depress laryngeal adductor neurons so laryngospasm is eventually self-limited
Causes of Upper Airway Obstruction
Congenital/Genetic: tonsils, macroglossia, micrognathia, neck mass, large adenoids
Infectious: tonsillitis, peritonsillar abscess, retropharyn. abscess, pretracheal abscess, epiglottitis, laryngitis, RSV, ludwig angina
Medical: CF, angioedema, laryngospasm, airway muscle relaxation, inflammatory, asthma
Trauma/Tumor: laryngeal trauma, hematoma, mass, smoke inhalation, thermal injury, FB
Airway Eqpt
- O2 and tubing
- ambu bag
- Bag-valve mask
- clear facemaks
- oropharyngeal airway
- nasopharyngeal airway
- suction
- pulse ox
- Co2 detector
- ETT
- laryngoscope blade/handle
- syringe
- magill forceps
- stylets
- tongue blade
- water-soluble lubricant or anesthetic jelly
- alternative device: LMA, combitube, king tube
- surgical rescue eqpt
- medications
NPPV
- provides positive pressure support
- forms of NPPV:
- HFNC - high flow nasal canula
- CPAP
- BiPAP
- CPAP and BiPAP are good for respiratory failure due to COPD and cardiogenic pulmonary edema
- NPPV reduces the WOB, increases lung volume, increases FRC
- redistributes pulmonary fluid to extra-alveolar tissues
- decreases preload and afterload, improves cardiac fxn
- increases PaO2 and decreases PaCO2
NPPV innappropriate if:
- ptp uncooperative, life-threatening cardiac ischemia, dysrhythmias, hypotension, absent resp effort
- severe maxillofacial trauma
- potential basilar skull #
- sever epistaxis
- bullous lung dz
- pneumonia
CPAP: reduces WOB, maintains inflation of atelectatic alveoli
- reduces preload and afterload and therefore improves cardiac output in LV failure
- 5-15cm H20 is usual presssure (>15cm can cause hypotension from decreases myocardial perfusion)
BiPAP: bilevel positive airway pressure
- pressure increases during insp and decreases during expiration
- setting 10-15cmIPAP/5cm EPAP
Cardiogenic Pulmonary Edema: NPPV improves mortality
COPD: NPPV improves hypoxia, acidosis, hypercapnia, shorter hospital stays, decreased intubation and mortality
- goal is not to correct pH too quickly, do not overshoot
NPPV: advantages/disadvantages
-advantages:
- less sedation
- early improvement hypoxia, acidosis, hypercapnia
- shorter stay
- decreased mortality
Disadvantages:
- anxiety, agitation
- air trapping –> decreased CO, hypotension
- pulmonary barotrauma
- respiratory alkalosis
- abdo compartment syndrome
