WEEK 4 - Airway management Flashcards
Why is airway management important?
- Airway management is an essential step as a means of achieving both oxygenation and ventilation
- Failure to manage and maintain the airway can lead to neurological dysfunction and even death within minutes
- airway management is defined as the provision of a free and clear passage of air flow
- Obstruction of the airway may be partial or complete and may occur at any level from the nose to the trachea
How does a childs airway differ from an adults?
- Tongue is larger in proportion to mouth
- Pharynx is smaller
- Epiglottis is larger and floppier
- Larynx is more anterior and superior
- Narrowest at cricoid
- Trachea narrow and less rigid
Describe the tounge
A muscular organ in the mouth
Covered with moist, pink tissue called mucosa
Tiny bumps called papillae give the tongue its rough
texture.
Thousands of taste buds cover the surfaces of the
papillae.
The tongue is anchored to the mouth by webs of tough
tissue and mucosa.
The tether holding down the front of the tongue is called
the frenum.
In the back of the mouth, the tongue is anchored into the
hyoid bone.
Loss of tone can result in airway blockage.
What is the tongue anchored to?
Tongue is anchored into the hyoid bone
What anchors the tongue to the mouth?
Webs of tough tissue and mucosa
At what GCS does a patient usually lose their gag reflexy
approximately 9
What are common causes of Upper Airway Obstruction
- Tongue
- Foreign body airway occlusion
- Laryngeal Spasm
- Larygeal Oedema
- Trauma
What are the most common cause of airway obstruction?
- Laxity of the tongue and other supporting muscles accompanying the decreased level of consciousness
- Vomitting into the upper airway with a loss of gag reflex
There is greater incidence of choking with elderly patients with neurological impairment such as:
- Muscular weakness (e.g MS, age)
- Past stroke
- Dysphagia - difficulty swallowing
- Depressed gag/cough reflec
Additional choking risk factors:
- Cough suppressants
- Poor detention or poorly fitting dentures
- Sedatives
- Alcohol
Groups at higher risk of choking
- Old age
- Children under 4
Why are children at greater risk of choking?
- Smaller airways
- put more shit in their mouth
- Swallowing and clearing mechanisms are less developed
- Young infants cannot control or easily change body position
- Unable to avoid clear an obstruction
What is laryngeal spasms
Essentially the involuntary spasm of vocal cords
What is laryngeal oedema
A swelling of the larynx
WHat does airway management mean un emergency care?
achieveing both oxygenation and ventilation
Define airway management
provision of a free and clear passage for airflow
What is the preferred head placement for airway management
Auditory meatus or tragus of ear in line with suprasternal notch
What are the 3 steps in a triple airway manoevre?
- Head tilt
- Jaw thrust
- Jaw support
What is the indication for Nasopharangeal airway (NPA)
PT with altered conscious state in the presence of trismus
What are the advantages of NPA
- better tolerated than OPA with semi-conscious PT
- less likey to induce vomitting
- able to be used in pts with trismus
- rapidly inserted
- no pre-set age, but length of NPA protruding from nostrol should not be excessive
What are the disadvantages of NPA?
- may cause epistaxis (nosebleed)
- Smaller internal diameter than OPA
- May be difficult to suction through
- Does not isolate trachea
- difficult to insert in the presence of nasal trauma
What are the contraindications for NPA?
- Middle third facial fracture
- Significant nasal trama
- traumatic brain injury and neurological event where airway is patent and tidal volume is adequate despite trismus
What are the precautions for NPA?
- base of skull fractures and mid facial fractures
- Cerebrospinal fluid from nares or ears
How do you size up an NPA
Nares to the tragus
