week 6 - airway Flashcards
order in which you check a patient
- airway
- breathing
- circulation
3 things checked for when assessing an airway
- patent
- protected
- functional
patency
ability of a person to breath, with air flow passing to and from the respiratory system through the oral and nasal passages
3 possible causes of failure of patency
- trauma - facial fracture, tracheal laceration
- allergy - angioedema of the tongue or pharynx
- disease process - prevents or impedes a clear trajectory for air to travel
nasal cavity
functions to humidify, warm, filter and act as a conduit for inspired air
paranasal sinuses
hollow spaces filled with air, located around the nose inside the skull
nasopharynx
most superior (upper) portion of the pharynx bounded superiorly by the skull base and interiorly by the soft palate. connects the nasal cavity to the oropharynx
hard palate
separates the oral cavity from the nasal cavity and from the floor of the nasal cavity and toor of the oral cavity
soft palate
the soft tissue constitutes the back of the roof of the mouth
oropharynx
middle part of the pharynx (throat) and is behind the mouth
tonsil
lymph nodes in the back of the mouth and top of the throat that help filter out bacteria and other germs to prevent infection in the body
tongue
muscular organ, and is formed by complex inartistic and extrinsic muscles
intrinsic muscles
change in the shape of the tongue
extrinsic muscles
in charge of moving the tongue in different directions
laropharynx
crucial connection point through which food, water and air pass
vocal cords
2 bands of smooth muscle tissue found in the larynx (voice box)
epiglottis
small, leaf-shaped sheet of elastic cartilage that protects your larynx (voice box) and helps you swallow
esophagus
tubular, elongated organ of the digestive system which connects the pharynx (throat) to the stomach and is the organ that food travels through to reach the stomach for further digestion
trachea
long, U shaped tube that connects your larynx (voice box) to your lungs
nares
nostrils
mandible
largest bone in the human skull (lower jaw)
thyroid cartilage
the largest cartilage of the larynx (voice box) and is composed of hyaline cartilage
hyoid bone
small U-shaped (horseshoe-shaped) bone that is situated in the midline of the neck anteriorly at the base of the mandible and posteriorly at the 4th cervical vertebrae
cricoid cartilage
serves to maintain airway patency and functions in the opening and closing of the vocal cords for sound protection
thyroid gland
produced hormones that regulate the body’s metabolic rate, growth and development and play a role in controlling the heart, muscle and digestive functions, brain development etc
5 components of the upper airways
- nose
- mouth
- sinuses
- pharynx (upper section of the throat)
- larynx (voice box).
5 components of the lower airways
- trachea
- lungs
- bronchi
- bronchioles
- alveoli.
stertorous respirations
snoring, vibrations of air sneaking through
- happens when the tongue drops down and blocks the airway
- airway is not protected or patent
what is the #1 thing well see in an unconscious patient
in the unconscious patient, the most common site of airway obstruction is at the level of the pharynx (throat) and the obstruction has usually been attributed to posterior displacement of the tongue caused by reduced muscle tone (tongue falls back blocking airway)
airway obstruction
a blockage in any part of the airway
2 types of obstruction
- partial
- complete/total
where can a partial or complete airway obstruction occur
any level from the nose to the trachea
causations of airway obstruction
- vomit
- blood
- swelling of the airway
- foreign body
- laryngeal spasm
choking
foreign body causing airway obstruction
partial choking
- can still breathe
- may be coughing
- may be talking
- watch and encourage them to cough
complete choking
- hands on the neck
- no sounds or noises
- complete blockage of the airway
- need help immediately
airway compromise
occurs whenever a traumatic or medical event causes a disruption in the natural and unimpeded flow of air through the airway structures
what becomes the top priority when the airway is compromised
airway management because the top priority in patient care
level of responsiveness
A - alert
V - verbal
P - pain stimulus
U - unresponsive
7 medical causations of airway compromise
- allergy (anaphylaxis)
- COPD
- vomiting
- asthma (respiratory infection)
- loss of consciousness
- seizure
- overdose (intoxication)
5 trauma causations of airway compromise
- hanging
- direct trauma
- head injury
- tongue bite
- burns
anything plus LOC (unresponsive) results in
airway compromise
cyanosis
lack of oxygen
what causes a seizure
electrical impulses all signaling and firing at once
airway swelling
swelling of the upper airways can cause life-threatening injuries because of the limited ability to move air
2 main things to do when treating a patient with a seizure
- keep their airway clear (make sure nothing is obstructing the airway)
- keep the patients safety a priority
what do you look for when assessing airway
- positioning
- fluids and secretions
- swelling
- injury
- adventitious sounds
what are we always assessing the airway for
patency
4 things looked for when assessing the airway for fluids and secretions
- vomit
- blood
- saliva
- mucus
what are you visualizing in a less responsive patient
oropharynx
turbulent airflow produces what type of sounds
- snoring/ sturtor
- stridor
what is turbulent airflow caused by
- poor position
- loss of motor tone (tongue)
- presence of secretions
- airway edema
assessing for airway for a responsive vs unresponsive patient
responsive
- observe for airway patency through speech (talking to them shows airway patency)
- visualize the head/ neck and inside of the mouth
unresponsive
- visualize the head and neck for positioning
- open the mouth and visualize the oropharynx for fluids and secretions and foreign objects
- listen for adventitious sounds
what is the first step in airway management
manual positioning
what is something to consider when checking for airway management in a patient
spinal injury (spinal immobilizations)
4 manual positioning techniques
- jaw thrust
- head tilt, chin lift
- sniffing posiiton
- ear to sternal notch (E2SN)
when to use jaw thrust
- risk of cervical spine injury
- can be used effectively on any patient
what does performing a jaw thrust do
- brings the mandible forward and relieves obstruction by the soft palate and epiglottis and lifts the tongue off the oropharynx
sniffing position
- this involves neck flexion (elevation of the head)
how is a sniffing position achieved
- by placing a pillow/blanket under the head and then extending the head at the atlas and occipital bone
which is the most preferred airway management position
ear to sternal notch
4 indications to use the ear to sternal notch technique
- decrease or unresponsive patient without suspected spinal injury
- position the blankets and pillows under the top of the shoulders and under the back of the head - face plane is parallel with ceiling
- ears should be level with the chest (sternal notch)
suctioning
- the presence of fluid or secretions like blood, vomit etc can result in aspiration and is life threatening
2 types of suctioning devices used
- VVAC (manual)
- Automated
VVAC suction technique
- for liquids use the “straw” attachment
- if there is thick or chunky matter do not use any attachment
how far do you suction
as far as you can see in the oropharynx
which suction is mandated by the MOH
VVAC
how long do you suction
10-15 seconds then reassess
for the portable (automated) suction at what suction pressure do you use
between 300-550 mmHg (depends on the rate of fluids produced or thickness)
oropharyngeal airways (OPA)
- a curved plastic device designed to follow the curvature of the palate
- once you size correctly place until you hit the hard palate then rotate it to insert
2 types of suction catheters for portable suction
- wide bore
- yankeur
when to use OPA
designed to be used in unconscious patients with no gag reflex that require airway support
indications and uses of OPA
indications
- unconscious
- no gag reflex
uses
- used to lift the tongue off the airway (create patency)
techniques for inserting a OPA
- hard palate
- soft palate
- rotate 180 degrees
- rest at teeth
Nasopharyngeal airway (NPA)
- designed to relieve soft tissue upper airway obstruction in a patient requiring airway support
- bevel to septum
indications to use a NPA
- decreased level of responsiveness
- requires airway support, but has intact gag reflex
- insert right nostril first
where do you measure for the sizing of a NPA
- measure from the tip of the nose to the trigs of the ear
contradictions of using a NPA
- basil skull fractures (bruising around the ey and ears or fluid)
- fluid leakage from the nose or ears (blood)
- should not be used on patients with significant facial and head trauma
3 ways to airway management
- positioning (4 techniques)
- suctioning (if needed)
- adjuncts (OPA/NPA)
