Airway Skills Flashcards
(10 cards)
what does DOPES stand for with examples
Indicated to identify and rectify potential causes of ventilation problems in sequential and structured manner.
Displacement look at the tube placement, look at the EtCO2 waveform, auscultation, cuff inflation and depth
Obstruction inability or resistance on ventilation good indicator of obstructions, clear the foreign body
Pneumothorax consider signs of a pneumothorax
Equipment failure check any all all equipment, is it connected correct?is there any leaks or complications from oxygen cylinder to airway adjective
Secretions thick mucus may obstruct, suction as required
Presentation of choking
Typically related to a foreign body airway obstruction that may cause either mild to severe airway obstructions, impairing gaseous exchange leading to hypoxia, brain damage, respiratory arrest and/or cardiac arrest
Common causes of upper airway obstructions may include small objects, medications, liquids, or sold food bolus
· Anxiety, agitation, gasping, coughing or loss of voice
· Paradoxical chest movements
· Events preceding
· Clutching neck
· Acute dysphasia
· Drooling
Mild/partial obstruction
· Able to speak
· Effective cough
· Nil difficulties breathing
· Discomfort or obstruction felt
· Crying or abnormal voice noises
Severe
· Unable to speak
· Coughing attempts are silent or ineffective
· Wheeze or strider or silent lungs
· Cyanosis
· Unable to breath, declines to respiratory arrest
· Decreasing or unconscious
Treatment of a choking
· Encourage cough, in conscious effective coughing
· Conscious with ineffective cough, administer 5 back blows than 5 chest thrusts (sharper than CPR), continue as long as conscious
· Unconscious, above vocal cords use laryngoscopy & magill forceps, if below consider inserting ETT aiming to send obstruction into right main bronchus only if authorised, consider crcicothyrotomy if all other attempts fail
· If patient unconscious and pulse less, commence cardiac arrest guideline
Indictation to use laryngoscopy & magill forceps
Identify and remove suspected foreign body from the hypopharynx that is preventing ventilation or spontaneous breathing
contraindications and precautions of laryngoscopy & magill forceps
Contraindicated in conscious gag reflex intact, do not use magill forceps if below vocal cords, spo2 reading of 90% and ventilation achievable and suspected epiglottis
Considerations if there is damaged to oral structures, vagal stimulation, exacerbation of hypoxia/hypercapnia, suspected spinal
Indications and contraindications of OPAs
Rapidly assist in maintaining the airway latency of an unconscious patient with at risk airway
Placement of OPA must not interrupt effective compressions in cardiac arrest
Gag reflex =remove
<6 insert without twisting due to soft pallet
Measure from centre of the lips to the angle of the mandible
If unable to insert due to trismus consider NPA
indications and contraindications of NPA
Assist in maintaining an airway with an adjunct when an OPA cannot be inserted
Contraindicated in significant nasal or mid-facial trauma and epistaxis
Never force an NPA, lubricants before insertion
Discontinue if patient shows signs of rejection
Indication and contraindication of igel
Manage and maintain compromised airway in the patient with absent pharyngeal and laryngeal reflexes
Contraindication = intact gag reflex
Stabilise head & neck to reduce displacement, check every time they are moved
EtCO2 must be applied when available
Discontinue if effective ventilations can not be achieved, GCS increases and gag reflex returns or patient attempts to remove, if igel is faulty, regurgitation occurs
indication and contraindications of cricothyroctomy
can’t intubate, can’t oxygenate with decreasing spo2, primary airway attempt is not feasible
Contraindicated in <6 years, open tracheal injury
Tactile procedure as it can become bloody
procedure of a cric
Verbalise you are going to undertake a surgical airway
· Maintain oxygenation and ventilation as best as possible
· Prepare equipment
· Prepare neck, (slightly of of stretcher)
· Stand on side of dominate hand, use non dominate to feel and hold laryngeal cage
· Longitudinal incision at least 3-4 dem through skin and subcutaneous tissue
· Separate the tissue and locate the cricothyroid membrane
· Stab with blade facing you until resistance of back wall, extend incision as far as possible until resistance of side wall, 180 rotation and reverse to extend incision to opposite wall, twist so blade is vertical to create hole, insert pinky finger to check and ensure in tracheal wall
· Insert bougie along pinkie finger no more than 15cm
· Feed size 6 ETT until balloon is in airway and no longer visible
· Inflate balloon and remove bougie
· Check placement
· Secure
· Attach EtCO2 and ventilate
Successful if continuous EtCO2 tracing, improved oxygen and bilateral equal chest wall movement
