WEEK3- Airways and breathing

Question 1

what makes up the upper airway

Answer 1

nose, pharynx, larynx (above the vocal cord)

Question 2

what makes up the lower airway

Answer 2

larynx (below the vocal cord), trachea, bronchi, bronchioles

Question 3

When is airway management needed

Answer 3

failure to oxygenate, failure to ventilate, and/or failure to maintain a patent airway.

Question 4

What are the 2 techniques performed for airway management

Answer 4

non-invasive and invasive

Question 5

what types of complications can occur ?

Answer 5

foreign body obstruction, unconscious, aspiration, burns, seizures, facial injuries and allergies/anaphylaxis

Question 6

what is aspiration

Answer 6

occurs when patients without sufficient laryngeal protective reflexes passively or actively regurgitate their gastric contents.

Question 7

What to do when patient choking

Answer 7

Get the patient to cough, if ineffective then:
apply 5 back blows
apply 5 abdominal thrusts
then continue both of these until choking has stopped.

Question 8

what to do if foreign body obstruction is present

Answer 8

open the mouth if can be seen remove with single finger sweep. REMEMBER DONT ATTEMPT A BLIND/REPEATED FINGER SWEEP.

Question 9

what’s postural drainage and give an example of when this would be conducted

Answer 9

assists the fluid drainage from the mouth by tilting patient’s head to the side.
needed for:
opa

Question 10

how do you suction

Answer 10

put catheter as far as you can see, apply suction by occluding vaccum port (the small hole on handle).
Dont apply suction for longer than 8 seconds at a time
suction= set at 80-100mmhg for children
suction= set at 100-120 mmhg
may need to be set higher and remember do it in a figure of 8

Question 11

when should you suction

Answer 11

when there’s fluid that can be seen
patient cant clear airway by coughing
unexplained increase in shortness of breath/RR/HR

Question 12

what’s the stepwise approach for airway management

Answer 12

head tilt chin lift/ jaw thrust, opa, npa, supraglottic airway device (igel), et intubation, cricothyroidotomy (LAST 2 NOT FIRST YEAR SKILL)

Question 13

head tilt chin lift advantages and disadvantages

Answer 13

advantages:
no equipment needed
it’s simple and non-invasive

disadvantages:
doesn’t protect from aspiration
can’t be conducted when patients have a c-spine injury

Question 14

aim and indication of head tilt chin lift

Answer 14

maintains airway patency and conducted on an unresponsive patient who has airway obstruction due to loss of pharyngeal muscle tone

Question 15

aim and indications of jaw thrust

Answer 15

maintains airway patency and conducted on an unresponsive patient who has airway obstruction dur to loss of pharyngeal muscle tone

Question 16

advantages and disadvantages of jaw thrust

Answer 16

advantages:
no equipment needed
simple and non-invasive
maintains neutral alignment when c-spine injury is present

disadvantages:
doesn’t protect from aspiration
difficult to maintain for a long time
requires a second person go give ventilations if needed

Question 17

contra-indications for jaw thrust

Answer 17

a responsive patient (unless they have a fractured jaw)

Question 18

contra-indications for head tilt chin lift

Answer 18

patient with a spinal injury

Question 19

when can you conduct OPA’s/ when can’t you conduct OPA’s

Answer 19

can conduct on an unresponsive patient with no gag-reflex
can’t conduct on a patient who has a gag reflex

Question 20

advantages and disadvantages of OPA’s

Answer 20

advantages:
easy to insert
simple and non-invasive

disadvantages:
doesn’t protect from aspiration and vomiting
tongue can be pushed back when being inserted which could make obstruction worse

Question 21

what does opa stand for

Answer 21

oropharyngeal airway

Question 22

how to select right size opa and what happens if incorrect size is given

Answer 22

measure from incisors to the angle of the jaw (too long-occludes airway) (too short-wont separate soft palate (tongue) from posterior wall of pharynx)

Question 23

How do you insert an opa

Answer 23

1. extend head and neck if possible
2. insert opa into mouth with the tip pointing towards the roof of the mouth
3. rotate 180 degrees when it reaches the tongue
4. ensure it’s been conducted correct by looking for chest rise and fall/listen for breath

Question 24

what does npa stand for

Answer 24

nasopharyngeal airway

Question 25

what are the advantages and disadvantages of npa

Answer 25

advantages:
doesn’t require the mouth to open
can suction throughout
can be tolerated by patients who aren’t unconscious

disadvantages:
doesn’t protect from aspiration
poor technique could cause bleeding

Question 26

when can you conduct NPA’s/ when can’t you conduct NPA’s

Answer 26

can be conducted on an unresponsive/reduced LOC person who has an intact gag reflex
can’t be conducted on a patient who can’t tolerate the procedure and must be cautious with patients who have a basal skull fracture OR patients with nasal polyps

Question 27

How to insert a npa

Answer 27

1. lubricate the npa, conduct on the right nostril first as known to cause less trauma
2. when inserting, follow the nasal floor parallel to the mouth
3. ensure no resistance is pushed as may cause bleeding
4. ensure put in correct by listening to breathe sounds/look for chest rise and fall
5. if blanching(whitening) appears take put and select a smaller size

Question 27

How to insert a npa

Answer 27

1. lubricate the npa, conduct on the right nostril first as known to cause less trauma
2. when inserting, follow the nasal floor parallel to the mouth
3. ensure no resistance is pushed as may cause bleeding
4. ensure put in correct by listening to breathe sounds/look for chest rise and fall
5. if blanching(whitening) appears take put and select a smaller size

Question 28

what is a supraglottic airway device (sad)

Answer 28

device that keeps airway open so unobstructed ventilations can be conducted
also helps cover the anatomical opening of the oesophagus which prevents vomit from escaping back up

Question 29

what’s the most common supraglottic airway device paramedics use

Answer 29

i-gel

Question 30

How to select the right size supraglottic airway

Answer 30

based on patients’ weight, usually size 4 can be used for most adults.

Question 31

when can SAD’s be used and when can’t SAD’S be used

Answer 31

can be conducted when BVM ventilations aren’t effective/ when intubation fails
can’t be conducted on any patient with a gag reflex OR on a patient who isn’t deeply unconscious or not unresponsive

Question 32

advantages and disadvantages of SAD’S

Answer 32

advantages:
allows better oxygen than BVM with an OPA
no need for continuous manual seal
doesn’t require laryngoscopy therefore easier then et intubation
allows protection from airway secretions

disadvantages:
doesn’t fully protect from aspiration/vomiting
can leak when high ventilatory pressures are required

Question 33

what are the normal values for breathing

Answer 33

12-20 breaths per minute = normal
less than 12 breaths per minute = bradypnea
more than 20 breaths per minute = tachypnea
0 = apnea (absent)

Question 34

what complications can occur (hyperventilation’s)

Answer 34

infection (sepsis)
chest infection
asthma
blood clot in lungs (pulmonary embolism)
COPD
anaphylaxis

Question 35

what complications can occur (hypoventilation)

Answer 35

drug overdose (like codeine, morphine and heroin)
head injury
stroke
seizure
metabolic problems

Question 36

what is bvm

Answer 36

bag-valve ventilation helps assist ventilations on a person who’s not breathing adequately
type of positive pressure ventilation- mixture of oxygen combined with other gases by increasing the pressure into the lungs

Question 37

when can bvm be conducted and when can’t bvm be conducted

Answer 37

bvm can be conducted when there’s respiratory failure. meaning their respiratory rate is less than 12 or more then 20

caution: be careful if severe gastric bleeding/ gastric contents is uncontrollable in the airway as can lead to aspiration (when gastric contents go into the lungs)

Question 38

advantages and disadvantages of bvm

Answer 38

advantages:
non-invasive
should be initial approach to respiratory failure
less advanced technique
provides a good level of oxygen by increasing intrathoracic pressure

disadvantages:
can cause gastric inflation and regurgitation
hard to maintain for long periods of time

Question 39

How do you use a bvm

Answer 39

1. attach oxygen to bvm
2. place mask over face (c/e grip) to get a good seal
3. lift chin and jaw into mask
4. squeeze bag gently and slowly so that chest rise, and fall can be seen
5. can be confirmed by an auscultation with a stethoscope

Question 40

what’s the correct rate to deliver ventilations

Answer 40

deliver 10 over a minute (same as 1 every 6 seconds)

Question 41

in what time should the bag be squeezed over

Answer 41

1 second