WEEK3- Airways and breathing Flashcards
what makes up the upper airway
nose, pharynx, larynx (above the vocal cord)
what makes up the lower airway
larynx (below the vocal cord), trachea, bronchi, bronchioles
When is airway management needed
failure to oxygenate, failure to ventilate, and/or failure to maintain a patent airway.
What are the 2 techniques performed for airway management
non-invasive and invasive
what types of complications can occur ?
foreign body obstruction, unconscious, aspiration, burns, seizures, facial injuries and allergies/anaphylaxis
what is aspiration
occurs when patients without sufficient laryngeal protective reflexes passively or actively regurgitate their gastric contents.
What to do when patient choking
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.
what to do if foreign body obstruction is present
open the mouth if can be seen remove with single finger sweep. REMEMBER DONT ATTEMPT A BLIND/REPEATED FINGER SWEEP.
what’s postural drainage and give an example of when this would be conducted
assists the fluid drainage from the mouth by tilting patient’s head to the side.
needed for:
opa
how do you suction
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
when should you suction
when there’s fluid that can be seen
patient cant clear airway by coughing
unexplained increase in shortness of breath/RR/HR
what’s the stepwise approach for airway management
head tilt chin lift/ jaw thrust, opa, npa, supraglottic airway device (igel), et intubation, cricothyroidotomy (LAST 2 NOT FIRST YEAR SKILL)
head tilt chin lift advantages and disadvantages
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
aim and indication of head tilt chin lift
maintains airway patency and conducted on an unresponsive patient who has airway obstruction due to loss of pharyngeal muscle tone
aim and indications of jaw thrust
maintains airway patency and conducted on an unresponsive patient who has airway obstruction dur to loss of pharyngeal muscle tone
advantages and disadvantages of jaw thrust
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
contra-indications for jaw thrust
a responsive patient (unless they have a fractured jaw)
contra-indications for head tilt chin lift
patient with a spinal injury
when can you conduct OPA’s/ when can’t you conduct OPA’s
can conduct on an unresponsive patient with no gag-reflex
can’t conduct on a patient who has a gag reflex
advantages and disadvantages of OPA’s
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
what does opa stand for
oropharyngeal airway
how to select right size opa and what happens if incorrect size is given
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)
How do you insert an opa
- extend head and neck if possible
- insert opa into mouth with the tip pointing towards the roof of the mouth
- rotate 180 degrees when it reaches the tongue
- ensure it’s been conducted correct by looking for chest rise and fall/listen for breath
what does npa stand for
nasopharyngeal airway
what are the advantages and disadvantages of npa
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
when can you conduct NPA’s/ when can’t you conduct NPA’s
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
How to insert a npa
- lubricate the npa, conduct on the right nostril first as known to cause less trauma
- when inserting, follow the nasal floor parallel to the mouth
- ensure no resistance is pushed as may cause bleeding
- ensure put in correct by listening to breathe sounds/look for chest rise and fall
- if blanching(whitening) appears take put and select a smaller size
How to insert a npa
- lubricate the npa, conduct on the right nostril first as known to cause less trauma
- when inserting, follow the nasal floor parallel to the mouth
- ensure no resistance is pushed as may cause bleeding
- ensure put in correct by listening to breathe sounds/look for chest rise and fall
- if blanching(whitening) appears take put and select a smaller size
what is a supraglottic airway device (sad)
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
what’s the most common supraglottic airway device paramedics use
i-gel
How to select the right size supraglottic airway
based on patients’ weight, usually size 4 can be used for most adults.
when can SAD’s be used and when can’t SAD’S be used
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
advantages and disadvantages of SAD’S
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
what are the normal values for breathing
12-20 breaths per minute = normal
less than 12 breaths per minute = bradypnea
more than 20 breaths per minute = tachypnea
0 = apnea (absent)
what complications can occur (hyperventilation’s)
infection (sepsis)
chest infection
asthma
blood clot in lungs (pulmonary embolism)
COPD
anaphylaxis
what complications can occur (hypoventilation)
drug overdose (like codeine, morphine and heroin)
head injury
stroke
seizure
metabolic problems
what is bvm
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
when can bvm be conducted and when can’t bvm be conducted
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)
advantages and disadvantages of bvm
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
How do you use a bvm
- attach oxygen to bvm
- place mask over face (c/e grip) to get a good seal
- lift chin and jaw into mask
- squeeze bag gently and slowly so that chest rise, and fall can be seen
- can be confirmed by an auscultation with a stethoscope
what’s the correct rate to deliver ventilations
deliver 10 over a minute (same as 1 every 6 seconds)
in what time should the bag be squeezed over
1 second
