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Flashcards in Airway and ventilation Deck (19):
1

Site of airway obstruction

Most commonest at soft palate and epiglottis rather than at tongue

2

Recognising airway obstruction

LOOK, LISTEN, FEEL

Partial obstruction:

- Inspiratory stridor (obstruction at larynx and above)

- Expiratory wheeze (Obstruction of lower airways)

- Gurgling (liquid in upper airways)

- Snoring (Partial pharynx obstruction)

-Crowing/stridor (laryngeal spasm)

3

Complete obstruction

See-saw movements

Accessory muscle use

Intercostal, subcostal recession and tracheal tug

4

Patients with tracheostomies

Obstruction at pharynx cannot occur

If tracheostomy is removed place bag-mask valve over face or intubate.

5

Choking patients

Mild obstruction: Cough and no other action

Severe:
1) 5 back blows:
2) Stand to the side and slightly behind patient
3) Support chest with 1 hand and lean patient forward
4) 5 sharp blows between scapulae with heel of hand
5) Stand behind patient with arms around the upper abdomen
6) Clenched fist around xiphesternum and thrust in and upwards
7) 5 abdominal thrusts
8) If needed alternate between back blows and abdominal thrusts
9) Unconscious patient-CPR
10) Laryngoscopy and remove FB with magill forceps

6

Basic technique for opening airway

Head tilt
Chin lift
Jaw thrust

Manual in line stabilisation

7

Head tilt

1st hand on patients forehead
Tilt head back gently
2nd hand under point of the patients chin and lift to stretch anterior neck structures

8

Jaw thrust

Identify angle of mandible
Index and other fingers placed behind angle of the mandible, apply upward and forward pressure to lift mandible
Use thumbs slightly open mouth with downward displacement of chin

9

FB in mouth

Finger sweep to remove solid material in mouth
Remove broken/displaced dentures
Leave well fitting dentures

10

Oxygen delivery

Mouth to mouth 16-17% oxygen delivery

Standard oxygen masks deliver 50% at high flow

Non rebreather masks deliver 85% at 10l per min

Maintain 94-98% or 88-92%

11

Gastric inflation

Malalignment of head and neck
Incompetent oesophageal sphincter
High inflation pressure

12

Alternative airway devices

Supraglottic airway devices (easier to insert and usually without interrupting compressions)
These include:

LMA: reduced gastric inflation and regurgitation. Does not protect against aspiration from above larynx

Proseal LMA

Igel

Laryngeal tube

13

Inserting LMA

Where possible continue chest compressions

Size 5 for men size 4 for women

Lubricate outer cuff

Flex neck and extend head if safe

Hold LMA like pen

Pass LMA passed the incisors with the outer curved sized pressed against palate until the post pharyngeal wall is reached.

Pass backwards and downards at 45 degress-jaw thrust at this point is helpful.

Inflate 40mls of air (30mls in women) or 60cmH2O

Auscultate chest to confirm position

Bite block to confirm position/bandage/tape

30 seconds for procedure-reoxygenate if difficulty.

14

LMA limitations

Pulmonary oedema
Bronchospasm
COPD

High airway resistance/poor lung compliance

Risk of hypoventilation due to gas leakage

Continuous chest compressions increase risk of gas leaks

Risk of aspiration

Need deeply unconscious patients-cough/laryngeal spasm

15

Proseal LMA

- Improved seal with larynx-better ventilation therefore better with cont. chest compressions
- Gastric drain
- Bite block

16

Laryngeal tube

Oesophageal cuff and pharyngeal cuff

17

See ATLS for intubation

See ATLS for intubation

18

Mechanical ventilation

Automatic ventilators
Initially 6/7ml/kg at 10breaths per min

Adv:
- Both hands are free for mask and airway
- Cricoid pressure and airway mx
- Intubated patients rescuer completely free
- Avoid excessive ventilation

19

Passive oxygen delivery

CPR and oxygen via oro-pharyngeal airway or face mask

Not recommended.