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Advanced Life Support (ALS) > Chapter 7: Airway Management and Ventilation > Flashcards

Chapter 7: Airway Management and Ventilation Flashcards

1
Q

What is the most common site for airway obstruction?

A

Pharynx - soft palate and epiglottis

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2
Q

What are some common causes for pharyngeal airway obstruction?

A 
Vomit/blood
Tongue
Regurgitation
Trauma
Foreign Body
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3
Q

What are some common causes for laryngeal airway obstruction?

A

Oedema from burns, inflammation or anaphylaxis

Spasm due to airway stimulation or foreign material

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4
Q

What can cause airway obstruction below the larynx?

A 
Bronchial secretions
Mucosal oedema
Bronchospasm
Pulmonary oedema
Aspiration of gastric contents

Extrinsic compression at any level

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5
Q

What is seesaw breathing?

A

Complete airway obstruction in a patient who is making respiratory efforts causes paradoxical chest and abdomen movement called see-saw breathing

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6
Q

What signs may be seen in airway obstruction?

A 
See-saw breathing
Use of accessory muscles
Reduced air entry 
Stridor/wheeze/gurgling/snoring
Intercostal and subcostal recession
Tracheal tug
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7
Q

How do you identify complete airway obstruction in patients with apnoea?

A

Spontaneous breathing movements are absent

Failure to inflate lungs during attempted positive pressure ventilation

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8
Q

How should patients with a tracheostomy or permanent tracheal stoma with an airway obstruction be managed?

A

Remove tube/stoma and replace

Ventilate by sealing stoma

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9
Q

What are the signs of severe choking?

A 
Not able to speak
Unable to breathe
Breathing sound wheezy
Attempts at coughing silent
Patient may be unconscious
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10
Q

What are the signs of mild choking?

A

Respond to question

Able to speak cough and breathe

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11
Q

How would you manage someone who is choking with a mild airway obstruction?

A

Encourage them to cough

Continually assess for deterioration

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12
Q

How would you manage someone who is choking with severe airway obstruction?

A

Conscious - 5 back blows and 5 abdominal thrusts

Unconscious - start CPR

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13
Q

How do you give back blows?

A
  • Stand to side and slightly behind patient
  • Support chest with one hand and lean patient forward
  • Give sharp blow between scapulae with heel of hand
  • Check to see if airway obstruction relieved after each blow
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14
Q

When and how do you do abdominal thrusts?

A

If back blows fail, give 5 abdominal thrusts

  • stand behind pt and put both arms round upper abdomen
  • place clenched fist under xiphisternum and grasp with other hand
  • pull sharply inwards and upwards
  • repeat 5 times
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15
Q

What should be done if 5 back blows and 5 abdominal thrusts hasn’t relieved airway obstruction?

A

Continue alternating back blows and abdominal thrusts

If pt become unconscious - begin CPR

Once appropriate individual arrive - laryngoscopy and remove FB with Magill forceps

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16
Q

How should the airway be opened in a patient with suspected C Spine injury?

A

Maintain head neck chest and lumbar region in neutral position

Can use jaw thrust or chin lift with manual in line stabilisation (NO HEAD TILT)

Can add head tilt if life threatening airway obstruction persist

17
Q

What airway adjuncts are available to use and how are they put in?

A

Nasopharyngeal - straight back usually right nostril with lube and twist motion
Oropharyngeal (Guedel) - measure with size of incissors to angle of jaw. Upside down then turn around.
Igel - shove in, teeth down to bite line !

Nasopharyngeal

18
Q

What oxygen should you give when doing CPR?

A

100% O2 until ROSC is achieved

After this, give high flow until Sa02 can be measured reliably

19
Q

What can you use to remove fluid in an airway obstruction?

A

Suction - wide bore rigid sucker (Yankauer)

Use cautiously if intact gag reflex

Fine bore may be req. if limited mouth opening

20
Q

What is the issue with high pressure airways due to inspiratory flows that are too high when ventilating?

A

Gastric inflation occurs –> regurgitation and vomiting and subsequent pulmonary aspiration

Also gastric inflation further reduce lung compliance making ventilation more difficult

21
Q

What tidal volume do you aim to provide when ventilating a patient? How quickly should it be given

A

6-7mL/kg

Give over 1s

22
Q

How much oxygen can you give in a self-inflating bag?

A

Air = 21%
High flow oxygen directly to bag = 45%
High flow oxygen in reservoir = 85%

23
Q

How can you reduce risk of gastric inflation?

A

Apply cricoid pressure

24
Q

What ways can you ventilate a patient?

A 
Mouth to mask ventilation
Self-inflating bag/bag-valve mask
Automatic resuscitators
Passive oxygen delivery
Laryngeal mask airway
I-Gel airway
Proseal LMA
25
Q

What are the limitations of a laryngeal mask airway?

A

Risk of significant leak if high airway resistance or poor lung compliance –> hypoventilation

Uninterrupted chest compressions can lead to gas leak

Theoretical risk of aspiration but v low

Difficult insertion if pt. not deeply unconscious

Won’t work if airway obstruction cause epiglottis to fold over laryngeal inlet

26
Q

What are the benefits and weaknesses of the proseal laryngeal mask airway over a standard LMA?

A

Additional posterior cuff and gastric drain tube

  • improved laryngeal seal enabling ventilation at higher pressure
  • regurgitated fluids can be drained

Weaknesses

  • more difficult to insert
  • relatively expensive
  • req. sterilisation between uses
27
Q

What are the advantages to intubation over bag mask ventilation?

A

Maintenance of patent airway that is protected from aspiration

Ability to provide adequate tidal volume during uninterrupted chest compressions

Free up recur hands

Ability to suction airway secretions

28
Q

What are the disadvantages to tracheal intubation over bag mask ventilation?

A

Risk of unrecognised misplaced tube

Prolonged time without chest compressions

Comparatively high failure rate

29
Q

What can be done in circumstances where intubation is contraindicated?

A

Use of anaesthetic drugs
Videolaryngoscopy
Flexible fiberoptic laryngoscopy

30
Q

What equipment is required for tracheal intubation?

A

Laryngoscope
Cuffed tracheal tubes
Syringe - cuff inflation
Equipment to confirm correct placement - aspirate

Other - water soluble lubricating jelly, Magill forceps, bougie/semi-rigid stylet, tape to secure, suction apparatus

31
Q

What is done after intubation?

A

Connect tube to ventilating device

Inflate cuff of tracheal tube - prevent leak

Confirm correct placement - clinical assessment and waveform capnography

Continue ventilation with high flow O2

Secure tube

32
Q

What does the clinical assessment involve when confirming a tracheal tube is located correctly?

A

Observe chest expansion bilaterally

Auscultate lung fields bilaterally in axillae (should hear breath sounds) and over epigastrium (shouldn’t hear here)

Check for condensation of tube

33
Q

How can CO2 be detected to confirm tracheal tube placement?

A

End tidal CO2 capnograph

Disposable colorimetric end tidal CO2 detectors (litmus paper):

  • purple if <0.5%
  • tan if 0.5-2%
  • yellow if >2%

Non waveform electronic digital end tidal CO2 device

34
Q

What factors may cause problems during intubation?

A

Facial burns and trauma
Upper airway pathology - cancer, infection, swelling
Insecure/loose teeth or dental prosthesis
Gastric regurgitation
Clenching of teeth
Oesophageal intubation
Possible C Spine Injury

35
Q

What aids are available for intubation?

A

Videolaryngoscopes
Introducers - bougie
Suction

36
Q

When is a cricothyroidotomy considered?

A

Impossibile to ventilate or pass tracheal tube

Tracheostomy too time consuming, hazardous or insufficient staff/equipment

37
Q

What are the options for a cricothyroidotomy and how is it done?

A

Surgical - leave airway that is protected by cuffed tube

Needle - wide bore cannula but temporary and prone to kinking

38
Q

What airway type is best

A

No studies have proven which is better.

As compressions are key, usually wait until after ROSC for intubation as dont want to interupt CPR

39
Q
A

Advanced Life Support (ALS) (9 decks)

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