Section II respiratory procedures Flashcards
Name a few conditions that make intubation in the emergency department different/more dangerous that in a controlled environment (OT)
1) hypoxia
2) shock
3) full stomach
4) presence of emesis
5) excessive airway secretions
6) Uncooperative/combative patient - unable to assess airway beforehand
7) Medical history/medications/allergies may be unknown
8) Diagnosis unknown
How many emergency airways need a surgical approach (front of neck)?
0.5 to 1% (though videolaryngoscope may be reducing this)
In a sedated patient, what is the cause for airway obstruction?
Primarily tongue moving posteriorly
Name two manual manouvers to open the airway
1) Head tilt/chin lift
2) Jaw thrust
Describe what happens to the mandible during a jaw thrust?
Anterior translation to bring the lower incisors anterior to upper incisors
Does a jaw thrust cause less cervical spine movement than a head tilt?
No, both jaw thrust and head tilt cause similar and substantial movement of the c-spine
However there is no evidence that either worsen an existing injury.
Accepted practice: use jaw thrust first, if this doesnt work, use head tilt and thurst
Can NPPV (non-invasive positve pressure ventilation) assist in opening the airway if manual manouvers don’t work?
Yes
A jaw thrust is successul the lower incisors are…?
Anterior to the upper incisors
Can jaw thrust be combined with a head tilt?
Yes
What is the ‘triple airway manouver’ and is it superior?
Head lift + chin tilt
Jaw thust
Mouth opening
Though evidence suggests the upper airway is more patent when the mouth is closed. No evidence suggests it is superior to head lilt /chin lift or jaw thrust
Is is acceptable to ramp a mobidly obese patient to ensure a good airway view even if there is a c spine trauma?
Yes, acceptable
What to mobidly obese patients need ramping ?
Fat deposition on back results in neck extension when lying supine
How is a sniff position achieve in a normal adult patient?
Neck flexed relative to torso +
atlanto-occipital extension
Elevate head approx 10cm while tilting head back so plane of face tilts slightly towards provider to head of bed
How do you achieve the sniffing position in children?
Often don’t need head lifting because occiput of large so low cervical spine is often flexed
What is the prognosis after massive aspiration of vomitus?
Often fatal as patient and clinician are unable to adequately clear the airway
What adjunct to a BVM can you use if struggling to ventilate a patient, especially if there is a foreign body?
Add on a peep valve and ventilate at high pressures
How do you perform an abdominal thrust (heimlich maneuver)
Radial side of of clenched fist placed on abdomen midway between xiphoid and umbilicus.
Fist is grasped and thrust inward and upward.
There is is evidence of this, but risk of stomach and eosphageal rupture, mesenteric laceration
Don’t performed in fat or pregnant. Sternal and back blows first
In a choking patient that hast lost consciousness, are chest compression just for circulation of blood?
No, chest compression helps clear obstruction
When giving breaths during CPR for a choking patient what should you do just before giving breaths?
Look for FB and remove it if possible
When delivering back blows and sternal thrust to an infant, should the head by up or down?
Down for both
Can abdominal thrusts be used in a choking infant?
No, only adults. Risk his higher for iatrogenic injury in children
Can back blows and sternal thrust be used on a newborn?
Ideally no , use suction first
