Week 2 Artificial Airways Management and Considerations Flashcards
What is Oropharyngeal airway?
- also known as Guedel airway
- it is inserted via mouth with sizes ranging from 0-5. Used for breathing, bag mask ventilation and suctioning
What is the Nasopharyngeal Airway
- inserted through the nostrils and has sizes of 6-10mm internal diameter. It is mainly used for suctioning
What is an ETT (Endotracheal Tube)
- GOLD STANDARD management
- Inserted into trachea
How do we insert an Oropharyngeal Airway?
- Extend the neck - patient is positioned with an extended neck for proper insertion
- Insert upside down - prevents pushing of the tongue
- Rotate it 180 degrees - as you advance rotate it 180 degrees
- Secure it in place - ensure endpiece is against mouth. Secure to avoid dislodgement
What are the complications of an Oropharyngeal Airway?
- Mucosal trauma
- Obstruction if airway is too small
- Posterior displacement of the tongue (we avoid this by inserting it upside down)
- Gagging and vomiting which may lead to Aspiration
- Biting on the tube (depends but it can help us secure the tube when you do the suctioning)
- Patient distress
How do we insert a Nasopharyngeal airway?
- look for the proper size (sizes are 6-10mm in internal diameter) - we can estimate this by looking at the patient’s pinky finger
- ensure lubrication by using a water based lubricant prior to insertion to avoid mucosal trauma
- Insert slowly and aim for the opposite eye (this is due to anatomical position of the nasal cavity)
- Make sure to secure it in place - ensure that the phlange sits flush against the nare, and secure it with a safety pin
what are the complications of Nasopharyngeal airway…
- mucosal trauma
- obstruction if size is too small
- Gagging and vomiting
- Patient distress
What are the indications for an Endotracheal Intubation?
- Take note ETT is the GOLD STANDARD FOR AIRWAY MANAGEMENT
- Indications are:
- acute airway obstruction
- facilitation of suctioning
- airway protection
- respiratory failure requiring ventilatory support
What are the techniques for endotracheal intubation?
- patient sedated and paralysed
- direct laryngoscopy and fibreoptic bronchoscopy. Pre-oxygenation and equipment preparation are essential
Give me information about the Endotracheal Intubation - Cuff..
- the tube has a balloon and is called “cuff” - which is inflated and sits below the larynx
- the cuff secures the tube and prevents aspiration of gastric and URT secretions
- it also ensures accurate delivery of gas from mechanical ventilator
- Cuffs are high volume and low pressure around 20-35mmHg and is checked via a monometer
- this is inflated by a tube that comes out of the patient’s mouth - a Pilot tube
Signs when the cuff is deflated:
- air is escaping the mouth
- Pilot tube is Deflated
Complications of overinflated cuffs:
- tracheal damage
- ischaemia
- May cause tracheal stenosis
- Tracheomalacia - softening of tracheal cartilages
What are the complications of Endotracheal tube intubation?
- During intubation:
- injury to mouth, dental damage, mucosal trauma, oesophageal intubation, recurrent laryngeal nerve injury, aspiration - While the tube is in place
- tube migration, blockage, loss of normal URT defenses, vocal cord damage - Post extubation
- Laryngeal damage, tracheal stenosis, aspiration, stridor (inflammatory process, can narrow airways and cause spasms), respiratory distress - reintubation, and sore throat (45%)
What is Tracheostomy?
- Accessing the airways through the trachea below the vocal cords. An ancient technique with modern improvements
What are the indications for Tracheostomy?
- bypass glottic/supraglottic obstruction
- provide airway access for mechanical ventilation
- may be surgical or percutaneous
- Timing of Tracheostomy
- no consensus but is often considered after approximately 2 weeks of intubation. Complex and multi-disciplinary decision making around need for prolonged airway support, risk vs benefit equation.
What are the benefits and disadvantages of Tracheostomy?
Benefits:
- Reduced airway resistance
- easier secretion clearance
- increased patient comfort and mobility
- facilitates weaning from Mechanical Ventilation
- More secure airway
- Facilitates speech and swallow
Disadvantages:
- Surgical complications
- tracheal damage
- permanent scare
- bypass normal URT defenses
- infection at stoma site
How do we assess patients with artificial airways?
- Observation - we check for respiratory distress, tube position and secretions
- Palpation - assess subcutaneous emphysema and proper tube placement
- Auscultation - listen for breath sounds, noting any differences due to artificial airways
- Special Considerations - assess ability to talk, cough effectiveness and overall patient comfort.
