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Advanced Life Support (ALS) > Chapter 7: Airway Management and Ventilation > Flashcards

Chapter 7: Airway Management and Ventilation Flashcards

1
Q

What is the most common site for airway obstruction?

A

Pharynx - soft palate and epiglottis

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2
Q

What are some common causes for pharyngeal airway obstruction?

A
  1. Vomit/blood
  2. Regurgitation
  3. Tongue
  4. Trauma
  5. Foreign Body
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3
Q

What are some common causes for laryngeal airway obstruction?

A
  1. Oedema - burns, inflammation or anaphylaxis
  2. Spasm - airway stimulation or foreign material
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4
Q

What can cause airway obstruction below the larynx?

A
  1. Bronchial secretions
  2. Bronchospasm
  3. Mucosal oedema
  4. Pulmonary oedema
  5. Aspiration of gastric contents
  6. Extrinsic compression at any level
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5
Q

What is seesaw breathing?

A
  1. Complete airway obstruction
  2. In a patient who is making respiratory efforts
  3. Causes paradoxical chest and abdomen movement
  4. Called see-saw breathing
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6
Q

What signs may be seen in airway obstruction?

A
  1. Stridor/wheeze/gurgling/snoring
  2. Use of accessory muscles
  3. Tracheal tug
  4. Intercostal and subcostal recessions
  5. Reduced air entry
  6. See-saw breathing
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7
Q

How do you identify complete airway obstruction in patients with apnoea?

A
  1. Spontaneous breathing movements are absent
  2. Failure to inflate lungs during attempted PPV
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8
Q

How should patients with a tracheostomy or permanent tracheal stoma with an airway obstruction be managed?

A
  1. Remove tube/stoma & replace
  2. Ventilate by sealing stoma
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9
Q

What are the signs of severe choking?

A
  1. Can’t speak
  2. Can’t breathe
  3. Breathing sound wheezy
  4. Attempts at coughing silent
  5. Pt. may be unconscious
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10
Q

What are the signs of mild choking?

A
  1. Able to breathe
  2. Able to cough
  3. Able to speak
  4. Respond to question
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11
Q

How would you manage someone who is choking with a mild airway obstruction?

A
  1. Encourage them to cough
  2. Continually assess for deterioration
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12
Q

How would you manage someone who is choking with severe airway obstruction?

A
  1. Conscious - 5 back blows and 5 abdominal thrusts
  2. Unconscious - start CPR
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13
Q

How do you give back blows?

A
  1. Stand to side & slightly behind patient
  2. Support chest with 1 hand
  3. Lean patient forward
  4. Give 5 sharp blows between scapulae with heel of hand
  5. Check to see if airway obstruction relieved after each blow
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14
Q

When and how do you do abdominal thrusts?

A

If back blows fail = give 5 abdominal thrusts

  1. Stand behind pt
  2. Put both arms round upper abdomen
  3. Place clenched fist under xiphisternum and
  4. Grasp with other hand
  5. Pull sharply inwards and upwards
  6. Repeat 5 times
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15
Q

What should be done if 5 back blows and 5 abdominal thrusts hasn’t relieved airway obstruction?

A
  1. Continue alternating back blows and abdominal thrusts
  2. If pt become unconscious - begin CPR
  3. Once appropriate individual arrive - laryngoscopy and remove FB with Magill forceps
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16
Q

How should the airway be opened in a patient with suspected C Spine injury?

A
  1. Maintain head, neck, chest and lumbar region in neutral position
  2. Can use jaw thrust or chin lift with manual in line stabilisation
  3. NO HEAD TILT

Can add head tilt if life threatening airway obstruction persist

17
Q

What airway adjuncts are available to use?

A

Oropharyngeal (Guedel)

Nasopharyngeal

18
Q

What oxygen should you give when doing CPR?

A
  1. 100% O2 until ROSC is achieved
  2. After this, give high flow until Sa02 can be measured reliably
19
Q

What can you use to remove fluid in an airway obstruction?

A
  1. Suction - wide bore rigid sucker (Yankauer)

  1. Use cautiously if intact gag reflex
  2. Fine bore may be req. if limited mouth opening
20
Q

What is the issue with high pressure airways due to inspiratory flows that are too high when ventilating?

A
  1. Gastric inflation
  2. Risk of regurgitation
  3. Risk of subsequent pulmonary aspiration
  4. Gastric inflation further reduce lung compliance - ventilation more difficult
21
Q

What tidal volume do you aim to provide when ventilating a patient? How quickly should it be given

A

6-7 mL/kg

Give over 1s

22
Q

How much oxygen can you give in a self-inflating bag?

A
  1. Air = 21%
  2. High flow oxygen directly to bag = 45%
  3. High flow oxygen in reservoir = 85%
23
Q

How can you reduce risk of gastric inflation?

A

Apply cricoid pressure

24
Q

What ways can you ventilate a patient?

A
  1. Mouth to mask ventilation
  2. Self-inflating bag/bag-valve mask
  3. Automatic resuscitators
  4. Passive oxygen delivery
  5. LMA - I-Gel airway, Proseal LMA
25
Q

What are the limitations of a laryngeal mask airway?

A
  1. Risk of significant leak if high airway resistance or poor lung compliance - hypoventilation
  2. Uninterrupted chest compressions can lead to gas leak
  3. Theoretical risk of aspiration but v low
  4. Difficult insertion if pt. not deeply unconscious
  5. Won’t work if airway obstruction cause epiglottis to fold over laryngeal inlet
26
Q

What are the benefits and weaknesses of the proseal laryngeal mask airway over a standard LMA?

A
  1. Additional posterior cuff and gastric drain tube
    - improved laryngeal seal enabling ventilation at higher pressure
    - regurgitated fluids can be drained

Weaknesses

  1. More difficult to insert
  2. Relatively expensive
  3. Req. sterilisation between uses
27
Q

What are the advantages to intubation over bag mask ventilation?

A
  1. Maintenance of patent airway that is protected from aspiration
  2. Ability to provide adequate tidal volume during uninterrupted chest compressions
  3. Free up recur hands
  4. Ability to suction airway secretions
28
Q

What are the disadvantages to tracheal intubation over bag mask ventilation?

A
  1. Risk of unrecognised misplaced tube
  2. Prolonged time without chest compressions
  3. Comparatively high failure rate
29
Q

What can be done in circumstances where intubation is contraindicated?

A
  1. Use of anaesthetic drugs
  2. Videolaryngoscopy
  3. Flexible fiberoptic laryngoscopy
30
Q

What equipment is required for tracheal intubation?

A
  1. Laryngoscope
  2. Cuffed tracheal tubes
  3. Syringe - cuff inflation
  4. Equipment to confirm correct placement - aspirate / stethoscope
  5. Water soluble lubricating jelly
  6. Magill forceps
  7. Bougie/semi-rigid stylet
  8. Tape to secure
  9. Suction apparatus
31
Q

What is done after intubation?

A
  1. Inflate cuff of tracheal tube - prevent leak
  2. Connect tube to ventilating device
  3. Confirm correct placement - clinical assessment and waveform capnography
  4. Secure tube
  5. Continue ventilation with high flow O2
32
Q

What does the clinical assessment involve when confirming a tracheal tube is located correctly?

A
  1. Check for condensation of tube
  2. Observe chest expansion bilaterally
  3. Auscultate lung fields bilaterally in axillae (should hear breath sounds) and over epigastrium (shouldn’t hear here)
33
Q

How can CO2 be detected to confirm tracheal tube placement?

A
  1. End tidal CO2 capnograph
  2. Disposable colorimetric end tidal CO2 detectors (litmus paper):
    - purple if <0.5%
    - tan if 0.5-2%
    - yellow if >2%
  3. Non waveform electronic digital end tidal CO2 device
34
Q

What factors may cause problems during intubation?

A
  1. Facial burns and trauma
  2. Upper airway pathology - cancer, infection, swelling
  3. Loose teeth or dental prosthesis
  4. Clenching of teeth
  5. Gastric regurgitation
  6. Oesophageal intubation
  7. Possible C Spine Injury
35
Q

What aids are available for intubation?

A
  1. Videolaryngoscopes
  2. Introducers - bougie
  3. Suction
36
Q

When is a cricothyroidotomy considered?

A
  1. Can’t intubate
  2. Can’t ventilate
  3. Tracheostomy too time consuming, hazardous
  4. Insufficient staff/equipment
37
Q

What are the options for a cricothyroidotomy and how is it done?

A

Surgical - leave airway that is protected by cuffed tube

Needle - wide bore cannula but temporary and prone to kinking

Advanced Life Support (ALS) (13 decks)

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