Management of the airway, ventilation and choking

Question 1

What are signs of airway obstruction?

Answer 1

Use of accessory muscles causing see-saw pattern of chest- chest drawn in and abdomen expands on inspiration and opposite on expiration.
Noise- partial obstruction will be grunting/wheezing/stridor. Complete obstruction complete silence
No airflow when hand held over the mouth

Question 2

What position should the head be placed in to ensure airway is optimised?

Answer 2

Infant- neutral position
Child- sniffing position
Jaw thrust

Question 3

What is the maximum level of suction in babies?

Answer 3

120mmHg

Question 4

What are OPAs intended for?

Answer 4

Unconscious patients
Otherwise risk of aspiration/laryngospasm

Question 5

How do you determine the size of an NPA

Answer 5

From the nostrils to the tragus

Question 6

When should NPAs be used?

Answer 6

For conscious patients or patients who conscious levels could improve quickly

Question 7

When are NPAs contraindicated?

Answer 7

In base of skull fractures or coagulopathy

Question 8

When should a non rebreathe mask with reservoir be used?

Answer 8

For an ill child who is breathing spontaneously

Question 9

When should blow by oxygen be used?

Answer 9

For children who are anxious and not tolerating the face mask. Carer holds the mask close to the face

Question 10

What is the normal resp rate for a child less than a year?

Answer 10

30-40 per min

Question 11

What is the normal resp rate for a 1-2 year old?

Answer 11

26-34 per min

Question 12

What is the normal resp rate for a 2-5 year old

Answer 12

24-30 per min

Question 13

What is the normal resp rate for a 5-12 year old?

Answer 13

20-24 per min

Question 14

What is the normal resp rate for children >12?

Answer 14

12-20 per min

Question 15

What should be done if a child is choking?

Answer 15

If child is coughing then encourage the child to do so- if child stops coughing or becomes too weak then need to intervene

Question 16

What are signs of an effective cough?

Answer 16

Crying or verbal response to questions
Loud cough
Able to take a breath between coughs
Fully responsive

Question 17

What are signs of an ineffective cough?

Answer 17

Unresponsive
Quiet or silent cough
Cyanosis
Unable to breathe
Unable to vocalise

Question 18

What should be done if a infant is choking with an ineffective cough?

Answer 18

Infant back blows- place child head down over lap. Support the head. give 5 blows between shoulder blades (check after each blow if obstruction has cleared)

Infant chest thrust- Turn infant onto back. Administer 5 chest thrusts (like chest compressions but sharper and harder . Check after each thrust the obstruction is relieved.

Question 19

What should be done if a child is choking with an ineffective cough?

Answer 19

Child back blows

Child abdominal thrust- stand behind child and arms around between umbilicus and xiphisternum. Grab hands and pull inwards and upwards in short sharp thrusts- 5 times.

Ensure check if obstruction is cleared between each thrust