PHEC - Airway Flashcards
(15 cards)
Advanced airway management - Indications:
Protect airway from obstruction.
Control oxygenation and ventilation.
Inability to clear/maintain airway using simple techniques – such as airway burns, anaphylaxis, reduced GCS
ET intubation definition
Passing of a cuffed endotracheal tube through the vocal cords and into the trachea
Surgical cricothyroidotomy definition
Placement of small cuffed tracheostomy tube, usually size 6 into trachea via an incision in the cricothyroid membrane
ETT - Indications – No Anaesthetic
ETT - Indications - Anaesthetic
Deeply unconscious casualty
Management of cardiac arrest
Casualty transfer
Pre-empt / Potential airway obstruction
Management of head/ chest injuries
ETT - Contraindications
Conscious patients
Trismus
ETT - Difficult intubation:
Trauma – facial
Shape – Anatomy or due to swelling
Pre-existing disease
ETT - Pre-procedure
OPA Size 2, 3 and 4
NPA Size 6.0 and 7.0
BVM
Suction Device
10 ml syringe
Lubricating jelly
1” Ribbon gauze
Scissors
Oxygen
Surgical gloves
ET Tubes 7.0, 8.0 and 9.0
Laryngoscope
Stethoscope
Gauze swabs
Magill’s forceps
Malleable ET introducer
Anaesthetic drugs
Catheter mount
Suction
Filter
ETT - Complications
Hypoxia – Take too long with insertion – hypoxia during the procedure
Failed intubation
Spinal cord injury
Damage to teeth, mouth or larynx
Laryngeal spasm
Oesophageal intubation
Intubation of right bronchus
ETT - Procedure
Follow MO instructions
Assist with oxygenation at 15l/min
Be prepared to take over hyperventilation (in preparation of no ventilation during actual ET insertion)
Prepare to apply cricoid pressure
Pass equipment as required
Inflate tube with 10 mls air
Have O2 and BVM ready
Attach BVM via catheter mount
Place OPA in right hand side of mouth as bite block
Once MO satisfied with ET placement:
Secure ET with ribbon gauze
Continue to ventilate casualty as required
ETT and Surgical Cricothyroidotomy - Post Insertion Care
Monitor and regularly assess respiration for signs of blockage and development of tension pneumothorax – SpO2, CO2, Chest movement, increased resistance when squeezing the bag, auscultation
Perform suction of mouth and ET tube
Arrange chest physio
Administer humidified oxygen to prevent chest infection
Surgical Cricothyroidotomy
Indications:
Trauma/burns to face and neck preventing safe ET intubation
Conscious casualty
Total upper airway obstruction
Laryngeal spasm
Surgical Cricothyroidotomy
Pre-procedure:
Cuffed tracheostomy tubes size 6.0 with connector
20ml 1% Lignocaine
5 and 20 ml syringes
Surgical sutures
23 gauge blue needles
Scissors
Gauze swabs
Ribbon gauze
Sharps box
Surgical gloves
Apron
BVM
Oxygen tubing and connector
Full O2 cylinder with flow meter
Scalpel handle with blade
Small artery forceps
Suction
Alcohol mediswabs
Surgical Cricothyroidotomy Procedure:
Follow MO instructions
Clean area around cricoid membrane with alcohol swab prior to anaesthetic
Prepare scalpel
Pass equipment to MO
Inflate tube cuff until adequate seal is achieved with 3–5mls air
Attach BVM and O2 to tube via catheter mount
Fix tube in place with ribbon gauze around neck
Ventilate as directed
Surgical Cricothyroidotomy Difficulties:
Casualty movement
Poor neck anatomy due to short neck, position of injury or swelling
Light and correct equipment essential
Position of operator and casualty critical
Surgical Cricothyroidotomy Potential Complications:
Damage to the carotid arteries (very unlikely)
Creation of a false passage into the tissues
Bleeding
Asphyxia
Aspiration of blood
Laceration of trachea/oesophagus
