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Trauma and Trauma Systems > Airway > Flashcards

Airway Flashcards

1
Q

upper airway

A
  • warms and moistens
  • everything above trachea
  • nasal passage
  • turbinates
  • oral cavity
  • epiglottis
  • vocal cord
  • esophagus
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2
Q

anatomy of the glottis

A
  • posterior tongue
  • epiglottis
  • vocal cords
  • > true vocal cords
  • > false vocal cords
  • esophagus
  • when tubing you want the tube to enter through glottis and into trachea
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3
Q

pediatric airway considerations

A
  • larger head and tongue
  • greater potential for airway obstruction
  • special attention to proper positioning
  • epiglottis is proportionally larger and floppier than adult
  • trachea is short and conical shape
  • trachea has greater potential for main bronchus intubation
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4
Q

airway assessment

A
  • if the trauma patient is talking normally, the airway is open
  • further assessment is still required
  • assessment of the airway requires the provider to:
  • look
  • listen
  • feel
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5
Q

look

A
  • look for findings that may indicate airway obstruction or injury or may lead to pulmonary aspiration
  • examples may include:
  • blood and secretions
  • fractured teeth
  • foreign bodies
  • vomitus
  • hematomas/contusions (tongue, neck)
  • gross subcutaneous emphysema
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6
Q

listen

A
  • listen for abnormal sounds indicating airway compromise
  • examples include:
  • snoring
  • stridor (inspiratory)
  • gurgling (expiratory)
  • hoarseness- upper
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7
Q

feel

A
  • feel for abnormal masses and signs of airway injury
  • examples include:
  • hematomas
  • subcutaneous emphysema in the neck
  • measure oxygen saturation
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8
Q

causes of airway obstruction: tongue

A
  • tongue
  • most common cause
  • falls back, obstructing the airway with decreased mental status
  • snoring- clinical finding
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9
Q

causes of airway obstruction

A
  • tongue
  • foreign body
  • blood
  • vomit
  • teeth
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10
Q

blunt injuries

A

examples of findings may include:

  • swelling and edema
  • fractured larynx
  • subcutaneous emphysema
  • hematoma
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11
Q

penetrating injuries

A
  • examples of findings may include:
  • bleeding into the airway
  • subcutaneous emphysema
  • hematoma
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12
Q

examples of causes of inhalation injury

A
  • dry
  • steam
  • chemical
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13
Q

signs and symptoms of airway burns

A
  • swelling/edema

- stridor

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14
Q

airway and spine stabilization

A
  • maintain cervical spine stabilization as indicated by mechanism of injury
  • especially important when assessing and performing airway maneuvers
  • stabilize spine before airway
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15
Q

goal of managing patients airway

A

-maintain a patent airway that allows for adequate breathing, ventilation, and oxygenation
-management progresses from essential to complex procedures and adjuncts
-Providers should be knowledgeable and skilled in multiple methods of ensuring a
patent airway

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16
Q

airway management skills

A
  • essential skills and interventions are applied FIRST- manual airway opening/OPA (NPA)
  • complex skills and interventions are performed ONLY if needed
  • the choice of technique to manage the airway depends upon:
  • knowledge and skills of provider
  • situation at the scene
  • severity of the patient
  • resources available
17
Q

manual management

A
  • trauma jaw thrust

- chin lift

18
Q

simple management

A
  • oropharyngeal airway (OPA)
  • nasopharyngeal airway (NPA)
  • adjuncts
19
Q

complex

A
  • supraglottic airways- just outside the trachea to seal it off and prevent fluids from getting in
  • endotracheal intubation
  • rapid sequence intubation (RSI)
  • percutaneous airway- needle through cricothyroid membrane
  • surgical airway
20
Q

jaw thrust or chin lift

A
  • ALWAYS the first airway maneuvers for the trauma patient
  • performed while maintaining manual cervical stabilization
  • both techniques lift the mandible, elevating the tongue away from the posterior, opening the airway
  • can be used for conscious or unconscious patients
21
Q

OPA and NPA

A
  • both airway adjuncts mechanically elevate the tongue off the poster pharynx to maintain an open airway
  • both airways require measurement (length) and sizing (diameter) prior to insertion
  • improperly sized or improperly inserted airways can cause obstruction by pushing the tongue against the posterior pharynx
  • OPA insertion requires an absent gag reflex
  • insertion technique is based on age of patient
  • NPA insertion requires the use of a water soluble lubricant
22
Q

supraglottic airways

A
  • bind insertion technique
  • less complex technique than endotracheal intubation
  • less initial training
  • easier to maintain proficiency
  • requires an absent gag reflex
  • occlude the pharynx to limit regurgitation but do not prevent aspiration
  • some supraglottic airways are available in pediatric sizes
  • ex. laryngeal mask airway (LMA), combitube, and king LT airway
23
Q

endotracheal intubation

A
  • complex technique
  • requires:
  • significant initial training
  • multiple pieces of equipment
  • substantial ongoing training to maintain proficiency
  • placement options: oral and nasal
  • oral- pharmacologically assisted intubation, rapid sequence intubation (RSI), nonpharmacologic
24
Q

endotracheal intubation: assess need for intubation based on:

A
  • inability to maintain a patent airway
  • decreased LOC
  • upper airway burns
  • signs of impending airway obstruction
  • endotracheal intubation may also be considered when alternate methods of airway management are deemed inadequate or inappropriate based on the situation and severity of injuries
25
Q

endotracheal intubation: before attempting intubation:

A
  • anticipate potential difficulties
  • trauma related
  • disrupted/displaced anatomy
  • pre-existing conditions
  • small mouth/mandible
  • short neck
  • obesity
  • prepare an alternate plan for airway management in the event of unsuccessful endotracheal tube placement
  • have all necessary equipment immediately at hand
26
Q

endotracheal intubation: important considerations

A
  • essential airway skills are often sufficient to provide a patent airway
  • if intubation is required:
  • preoxygenate to maximize oxygen saturation
  • reoxygenation patient in between intubation attempts
  • monitor oxygen saturation (pulse oximetry)
  • throughout the procedure
  • follow intubation, verify proper tube placement
27
Q

surgical airways: complex techniques

A
  • requires:
  • significant initial training
  • multiple pieces of equipment
  • substantial ongoing training to maintain proficiency
28
Q

surgical airways considerations

A
  • has potential for :
  • multiple complications
  • damage to nearby anatomic structures
29
Q

surgical airways: population

A

may be considered for:

  • massive facial trauma that prevents endotracheal intubation
  • upper airway obstruction unrelieved by other techniques
  • failed intubation and alternative airway methods are unavailable or unsuccessful
30
Q

confirmation of tube placement

A

-constant end-tidal carbon dioxide monitoring

physiological:

  • breath sounds
  • chest rise
  • change in skin color
  • pulse rate
  • continually monitored and reassessed

mechanical:

  • end tidal CO2
  • colorimetric - outdated
  • capnometry
  • wave form capnography
  • pulse oximetry
31
Q

summary

A
  • goal is to secure and maintain a patent airway
  • assess airway by looking, listening, and feeling
  • maintain manual stabilization of the head and spin as indicated
  • apply essential airway maneuvers first
  • utilize complex airway techniques only when required
  • anticipate difficulties and plan and prepare for alternate methods of airway control

Trauma and Trauma Systems (18 decks)

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