Flashcards in Airway Management, Adjuncts and the Choking Patient Deck (43)
'Initial Examination of Airway' - steps
Response - AVPU
Look for and remove obvious obstructions
Aspirate if necessary
Ensure patient airway
what are the 'Signs of normal breathing'
Even, bilateral rise and fall of the chest
Sound of air entering and leaving the nose and/or mouth
Feeling of air movement on your cheek
Normal skin colouration
Rate and depth of breathing adequate to sustain life
(Upper airway obstruction) Foreign body airway obstruction (FBAO) - cause
Tongue - most common cause in an unconscious patient
Foreign bodies - most common cause in a conscious patient: Blood, Saliva, Vomit, Displaced dentures, Food, Chewing gum, Extraneous small objects
Lower airway obstruction - cause
Excessive bronchial secretions
Aspiration of regurgitated gastric contents
Partial Airway Obstruction - signs
Their is usually reduced air movement, the noise produced depends upon the nature and site.
Upper airway is more noticeable during inhalation whilst an obstruction of the lower airway is usually more apparent during exhalation.
Other airway noises: Gurgling
May indicate liquid or semi-solid material in the airway
Other airway noises: Snoring
May indicate a partial occlusion by the tongue
Other airway noises: Complete obstruction
No air movement will be heard or felt. But there may still be abdominal and chest movement
opening airway: head tilt/ chin lift
brings the tongue forward and upwards and so ensuring an open airway.
opening airway: Triple airway manoeuvre
Similar to jaw thrust manoeuvre except you maintain traction of the head using the heels of your hands
opening airway: Jaw thrust
For trauma patients.
Hold mouth open by downward movement of the chin with thumbs.
Using index fingers apply steady pressure upwards and forwards at the angles of the jaw to lift it.
Open and inspect the mouth, carefully sweep two fingers from the side to the back, and hook out any foreign matter found, remove also any loose or broken dentures ONLY when clearly visible and very near to the lips.
Remove any blood/liquids/light solids by aspirating with appropriate catheter.
Mild airway obstruction
in response to "are you choking?"
patient answers "yes"
other signs - can speak, cough, breathe
Severe airway obstruction
in response to "are you choking?"
patient is unable to speak and may respond by nodding.
other signs - Unable to breathe, wheezy, attempts at coughing are silent, may be unconscious.
universal sign of choking
clutching the neck
management for: Mild airway obstruction - Adults
Encourage to cough and do nothing else.
Rapid transport to hospital
management for: Severe airway obstruction - Adults
How to do: Back Blows
Stand to the side and slightly behind.
Support the chest (hold shoulder) and with one hand lean the patient forwards.
Give up to five sharp back blows between the scapulae.
How to do: Abdominal Thrusts
Stand behind the patient and place both arms around the upper part of the abdomen, clench your fist and grasp with the other hand.
Pull sharply & upwards with the aim of producing sudden expulsion of air and foreign body form the airway.
Airway obstruction: adult unconscious
if a patient is or becomes unconscious begin basic life support.
During CPR check the mouth for any foreign body that has been partly expelled.
Airway obstruction: children and infants.
Suspect that a child may be choking if there is:
Sudden respiratory compromise with associated coughing, gagging or stridor (creaking or grating noise).
No other signs of illness.
Other clues - eating, playing with small toys immediately prior
DO NOT PERFORM BLIND FINGER SWEEPS. airway obstruction may also occur with acute epiglottis or croup
General signs of airway obstruction:
coughing or choking
recent history of playing with, or eating, small objects
Signs of ineffective cough
unable to vocalise
quiet or silent cough
unable to breath
decreasing level of consciousness
Signs of effective cough
Crying or verbal response to questions
able to breath before coughing
Airway obstruction: back blows for infant and child
Position in the prone position with the head lower then the chest.
Deliver up to 5 back blows to the middle of the back between the scapulae.
With an infant hold them across your forearm and a child across your thigh whilst sitting.
Airway obstruction: chest thrusts for infant or child
Turn the child into a supine position again with head lower than the chest and the airway in an open position.
Give up to five chest thrusts to the sternum - the technique for chest thrusts is similar to that for chest compression.
Chest thrusts should be sharper and more vigorous than compressions and carried out at a rate.
foreign body airway obstruction
FBAO child - effective coughing
encourage to cough. do nothing else
rapid transport to hospital