Chapter 9: Airway Management Flashcards
(27 cards)
Pediatric Airway Physiology
the mouth and nose are smaller and more easily obstructed than in adults, The tongue takes up more space proportionately in the mouth than in adults, Newborns and infants typically breathe through their noses. Nasal obstruction can impair breathing, The trachea (windpipe) is softer and more flexible in infants and children, The trachea is narrower and is easily obstructed by swelling or foreign objects, and the chest wall is softer, and infants and children tend to depend more on their diaphragms for breathing than do adults.
Airway Obstructions
Foreign bodies such as food and small toys are common obstructions, as are fluids, including blood and vomit, airway can even be obstructed by the patient, and conditions such as altered mental status and neurologic disorders can result in a loss of this muscle tone and lead to collapse of the airway
Bronchoconstriction
Changing the internal diameter even slightly causes a significant increase in the resistance to airflow and can seriously impact the patient’s ability to move air
Stridor
caused by severely restricted air movement in the upper airway. As air is forced by pressure through a partial obstruction, a high-pitched, sometimes almost whistling sound can be heard. stridor indicates a severely narrowed passage of air and suggests near obstruction.
Hoarseness
Voice changes, such as stridor, often reflect a narrowing of the upper airway passages. Voice changes are often useful in assessing an ongoing airway issue. For example, in a person whose airway is swelling after a burn, you may note a normal voice to begin with, but a raspy voice as the swelling builds up around the vocal cords. The development of hoarseness is often an ominous sign
Snoring
the sound of the soft tissue of the upper airway creating impedance (or partial obstruction) to the flow of air. Many persons normally snore while asleep but snoring in the case of injury or illness can often indicate a decrease in mental status such that airway muscle tone is diminished. It is also an indication that the airway needs assistance to stay open.
Gurgling
the sound of fluid obstructing the airway. As air is forced through the liquid, the gurgling sound is made. Common liquid obstructions include vomit, blood, and other airway secretions. Gurgling is a sign that immediate suctioning is necessary.
The Airway in primary Assessment
There are really two questions you must consider when assessing a patient’s airway: “Is the airway open?” and “Will the airway stay open?
Look
Visually inspect the airway to ensure it is free from foreign bodies and obvious trauma, look for visual clues of potential airway dangers such as facial burns, external neck trauma, and bleeding in and around the mouth and nose, look for visual signs of breathing such as the chest rising, and look at the patient’s position. Does the patient need to sit bolt upright to keep breathing?
Listen
Listen for the sound of breathing, and listen for sounds of obstructed air movement such as stridor, snoring, gurgling, and gasping
Feel
Feel for air movement at the mouth, and feel the chest for rise and fall
Will the Airway stay open?
Are there immediate correctable threats, If no airway, then open it, consider how you might keep an unstable airway open, and Consider ALS for more definitive airway care
Are there potential threats that may develop later?
Reassess, reassess, reassess, assess for signs of impending collapse such as stridor or voice changes, consider conditions that may later threaten the airway (such as anaphylaxis), and consider the patient’s mental status. Can the patient maintain and protect the airway? Will that mental status likely change over time?
Signs of Inadequate Airway
There are no signs of breathing or air movement, there is evidence of foreign bodies in the airway, including blood, vomit, or objects such as broken teeth, no air can be felt or heard at the nose or mouth, or the amount of air exchanged is below normal, the patient is unable to speak or has great difficulty speaking, The patient’s voice has an unusual hoarse or raspy quality, Chest movements are absent, minimal, or uneven, Movement associated with breathing is limited to the abdomen, Breath sounds are diminished or absent, Noises such as wheezing, stridor, snoring, gurgling, or gasping are heard during breathing, In children, there may be retractions (a pulling in of the muscles) above the clavicles and between and below the ribs, and Nasal flaring (widening of the nostrils of the nose with respirations) may be present, especially in infants and children.
Providing an Airway: Manual Maneuvers
require ongoing interventions to support airway patency, caused by lack of tone in the muscles that keep the airway open, basic procedures for opening the airway help to correct the position of the tongue and therefore move laryngeal tissues such as the epiglottis out of the way of the glottic opening, and Two procedures are commonly recommended for opening the airway: the head-tilt, chin-lift maneuver and the jaw-thrust maneuver
Head-tilt chin-lift maneuver
Once the patient is supine, place one hand on the forehead and place the fingertips of the other hand under the bony area at the center of the patient’s lower jaw, tilt the head by applying gentle pressure to the patient’s forehead, use your fingertips to lift the chin and to support the lower jaw. Move the jaw forward to a point where the lower teeth are almost touching the upper teeth. Do not compress the soft tissues under the lower jaw, which can obstruct the airway, and do not allow the patient’s mouth to be closed. To provide an adequate opening at the mouth, you may need to use the thumb of the hand supporting the chin to pull back the patient’s lower lip. Do not insert your thumb into the patient’s mouth
Jaw-Thrust Maneuver
Carefully keep the patient’s head, neck, and spine aligned, moving the body as a unit as you place the patient in the supine position, Kneel at the top of the patient’s head. For long-term comfort, it may be helpful to rest your elbows on the same surface as the patient’s head, carefully reach forward and gently place one hand on each side of the patient’s lower jaw, at the angles of the jaw below the ears, using your index fingers, push the angles of the patient’s lower jaw forward, You may need to retract the patient’s lower lip with your thumb to keep the mouth open, and Do not tilt or rotate the patient’s head.
Airway Adjuncts
devices that aid in maintaining an open airway, may be used to initially assist in the opening of an airway, and may be continually used to help keep an airway open. Two most common, oropharyngeal airway and nasopharyngeal airway.
rules for using airway adjuncts
Use an oropharyngeal airway only on patients who do not exhibit a gag reflex, patient with a gag reflex who cannot tolerate an oropharyngeal airway may be able to tolerate a nasopharyngeal airway, Open the patient’s airway manually before using an adjunct device, when inserting the airway, take care not to push the patient’s tongue into the pharynx, Have suction ready prior to inserting any airway, Do not continue inserting the airway if the patient begins to gag, When an airway adjunct is in place, you must maintain the head-tilt, chin-lift maneuver or jaw-thrust maneuver and monitor the airway, After an airway adjunct is in place, continue to be ready to provide suction if fluid such as vomitus or blood obstructs the airway, If the patient regains consciousness or develops a gag reflex, remove the airway immediately, and Use infection-control practices while maintaining the airway. Wear disposable gloves. In airway maintenance, there is a chance of a patient’s body fluids coming in contact with your face and eyes. Wear a mask and goggles or other protective eyewear to prevent this contact
Oropharyngeal Airway
curved device, usually made of plastic, that can be inserted into the patient’s mouth, has a flange that will rest against the patient’s lips. The rest of the device moves the tongue forward as it curves back to the pharynx.
Steps for inserting OPA
place patient on his back, use appropriate manual method to open airway, open the mouth with a crossed-finger technique, position the airway device with the tip pointing toward roof of mouth, insert the device along the roof of mouth, gently rotate airway 180 degrees so the tip is pointing down into patient’s pharynx, position the patient, check that the flange of the airway is against the patients lips, and monitor the patient closely.
Nasopharyngeal Airway
used when there is an intact gag reflex, teeth are clenched, or there are oral injuries. may be contraindicated with basilar skull fracture, epistaxis, or nasal trauma. Soft flexible airways should be used in the field rather than clear rigid, plastic airways.
Steps for Inserting NPA
measure the correct size from nostril to tip of the earlobe or the angle of the jaw, lubricate the outside of the tube with water-based lubricant before insertion, push the tip of the nose upward and insert the airway, insert into the nostril
Supraglottic Airway
isolate the glottic opening by occupying space in the larynx and the hypopharynx. airways are indicated when other, basic measures have failed, may also be used in the airway must be maintained over a long period, and specific insertion steps vary by airway manufacturer.
