Chapter 7 Flashcards
(19 cards)
Most common site of airway obstruction in unconscious patient
Pharynx - at soft palate and epiglottis
Signs of partial airway obstruction
Inspiratory stridor - obstruction at laryngeal level or above (upper airway)
Expiratory stridor - lower airway obstruction
Gurgling - liquid or semisolid foreign material
Snoring - partial occlusion of pharynx by tongue/palate
Signs of complete airway obstruction
Paradoxical chest/abdomen movement - see-saw
Accessory muscle use
Tracheal tug
Silent breath sounds
How to manage airway obstruction in patients with tracheostomies/laryngectomies
Remove obvious foriegn material
Remove tracheostomy liner
Suction using suction catheter
If not able to pass suction catheter remove tracheostomy and tube and exchange it
If tracheostomy may be able to ventilate via mouth, if laryngectomy can only ventilate via stoma
Algorithm for management of choking
Assess severity (are they able to speak, cough, breathe?)
Mild - encourage cough
Severe - if conscious give 5 back blows then 5 abdominal thrusts (if unsuccessful continue to alternate). If unconscious start CPR.
Once available - person with appropriate skills can undertake laryngoscopy and attempt to remova foreign body with Magill’s forceps
Basic airway manoeuvres
Head tilt and chin lift
Jaw thrust (better if suspected c-spine injury)
How to measure oropharangeal airway
Distance between incisors and angle of the jaw
Technique for insertion of oropharangeal airway
Remove any foreign body/material - suction if required. Don’t want to push anything backwards down airway
Insert upside down until hard palate then rotate 180 degrees, advance until within pharynx
Remove if patient gags or strains
Maintain head tilt chin lift or jaw thrust once inserted
Can suction through oropharangeal airway with narrow suction catheter
How and when to use nasopharyngeal airway
Tolerated better than oropharangeal in patients more conscious
DO NOT USE IN KNOWN/SUSPECTED BASAL SKULL FRACTURE - gentle insertion may be life saving so benefits may outweigh risks
Is mouth-to-mouth recommended?
No - risk of transmission of infection. No longer recommended.
Maximum oxygen that can be delivered by bag-valve mask
85% if used with reservoir and maximum flow oxygen
Is passive oxygen delivery recommended?
No
When should an i-gel be used?
Preferrable to bag-mask ventilation - reduced risk of gastric inflation and regurgitation
Useful if tracheal inbutation failed
How is an i-gel inserted?
Try to maintain chest compressions during insertion
Choose correct size - usually size 4 for adults (3 for small, 5 for tall)
Lubricate back, sides and front of cuff
Hold bite block, outlet of cuff pointing towards patient’s chin
Patient should be in sniffing morning air position
Insert with soft tip first, pointing towards hard palate
Insert until resistance felt - tip at oesophageal opening, cuff against larynx
Secure with strap/tape
Ventilate 10 breaths/minute
Continuous chest compressions once inserted
What are the limitations of i-gels?
May have significant leak if high airway resistance or poor lung compliance - may cause some gastric inflation
Continuous chest compressions likely to cause some gas leak - if too much leakage continue with 30:2
Theorectical risk of aspiration of stomach contents
If not deeply unconscious insertion may cause coughing, straining, laryngeal spasm
When can LMA be used?
Preferrable to bag-mask ventilation
If tracheal intubation not possible (no one available to do) or failed
Risks associated with tracheal intubation
Unrecognised misplaced tracheal tube - up to 17%
Prolonged chest compression interruption during insertion
High failure rate
How to confirm tracheal tube position
Waveform capnography - can detect oesophageal intubation but not intubation of a main bronchus, need to clinically assess
Auscultation lungs + epigastrum (should not hear breath sounds in epigastrum)
Chest expansion
?CXR
When is cricothyroidotomy recommended for airway management?
If unable to use other airway management e.g. extensive facial trauma or laryngeal obstruction
Contraindicated in an emergency as is time consuming, hazardous and requires surgical skill/equipment. Can cause substantial bleeding.
Needle cricothyroidotomy not recommended
Surgical cricothyroidotomy only used by those trained in the technique
