Mod D Tech 24 Airway management Assisting the Paramedic

Question 1

Airway management

Key Tasks (1)

Answer 1

• Clearing the airway of any obstructions & maintaining adequate oxygenation as directed
• Preparation of equipment required for endotracheal intubation
• Application of Cricoid Pressure, as required
• Assisting in the manipulation of the larynx, as required
• Assisting in the positioning or the re-positioning of patients where necessary
• Securing Endotracheal Tubes/Laryngeal Mask Airways / I-Gels
• Monitoring of the patient’s airway/condition, continually notifying any changes to the clinician immediately

Question 2

Airway management must be what?

Answer 2

Airway management must be rapid and effective

Stepwise airway management employs a series of increasingly complicated manoeuvres to open and maintain the airway, used in stepwise order, the simplest and most rapidly applied first

Question 3

Airway Adjuncts

Answer 3

for Technician

• Oropharyngeal Airway
• Nasopharyngeal Airway
• I-Gel

Question 4

Manual methods of Airway Control

Answer 4

• Head tilt / Chin lift
• Trauma jaw thrust
• Suction / manual clearance
• Recovery Position

Question 5

Endotracheal Intubation

equipment

Answer 5

• Bag & Mask
• •Oxygen
• •Laryngoscope with spare bulb and batteries
• Magill forceps
• Suction equipment
• Lubrication gel and gauze swabs
• •Endotracheal tube
• •20ml syringe
• •Spencer Wells Forceps
• •Oropharyngeal airway
• Thomas ET Tube holder or ribbon gauze or tape for securing the tube
• •Bougie / introducer
• •Catheter mount and tubing
• •Stethoscope

Question 6

Cricoid Pressure

Sellick’s Manoeuvre

Answer 6

• Often gets confused with Laryngeal pressure – if in doubt ask the clinician what it is they want
• To occlude airway and reduce the risk of regurgitation

Remember to remove pressure and stand clear if pt is about to vomit – risk of oesophageal rupture

Question 7

Laryngeal Pressure (BURP)

Answer 7

Backwards

Upwards

Right

Pressure

To aid in laryngoscopy improving visualisation of larynx / glottic opening

Question 8

Needle Cricothyroidotomy

Equipment:

Answer 8

Equipment:

• 14G cannula with 10ml syringe attached
• •Oxygen tubing
• •Oxygen supply with ability to deliver 10 – 15 l/min flow
• •Equipment to regulate oxygen flow. (May be substituted by a hole cut into the tubing)

Question 9

Needle Thoracocentesis should only done when

Answer 9

• Should only be performed in the presence of convincing signs of a tension pneumothorax
• The need for emergency decompression of the chest is rare

Question 10

Needle Thoracocentesis

Answer 10

In a non ventilated patient:

• Severe and increasing breathlessness (>30 / min)
• Decreased or absent breath sounds on one side of the chest
• Reduced chest movement or over-expanded chest on the affected side
• Distended jugular veins (if not hypovolaemic)
• Tachycardia
• Shocked
• Reduced SaO2 (often < 85%)
• Hyperresonance on affected side
• Deviated trachea (late sign)

Cyanosis (late sign)

Question 11

Needle Thoracocentesis Method 1

Answer 11

• Ensure adequate ventilation with 100% O2
• Expose the chest
• Clean the skin over the 2nd intercostal space in the mid-clavicular line
• Connect a 10ml syringe to a 14G – 16G cannula
• Insert at a 90° angle
• Withdraw air as you advance, until free flow of air enters the syringe
• Advance cannula and remove syringe and needle to allow a rush of air out of the chest

Method (2)

• Secure cannula with tape
• DO NOT refit cannula cap – leave open to the air
• Listen to the chest and reassess the patient
• Connect ECG and Pulse Oximeter
• LOAD and GO

Pre alert the hospital