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Flashcards in Respiratory - Assessing & Managing Airway Deck (41)
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What does the pneumonic PASS RESPS mean?

Position of patient
Speech - number of words/breath
Sounds - listen to lungs/breathing

Resp rate
Effort - using accessory muscles?
Skin - colour, condition
State of consciousness


Respiratory conditions - First assessment:

1. Patient position, Are they tripoding, supine or reclining?
2. Speech, Are they able to talk? sentences or 2-3 words only.
3. Appearance, Look for factors that affect respiratory function.
- Distended abdomen, obesity or pregnancy.
4. Behaviour, Signs of fear, restlessness, agitation, combativeness, confusion or unresponsiveness. All signs related to the level of respiratory distress.
5. Equipment, Oxygen & masks usually indicate chronic respiratory illness.


What are some signs in pediatrics of respiratory distress?

Tachypnoea - fast respiration rate
Nasal flaring
Weak cry
Indrawing or retraction
Accessory muscle use
Abnormal positioning eg sitting forward, tripod position, refusing to lie down
Head bobbing


Respiratory conditions - Signs

1. Listen - Audible noises that indicate a partial obstruction i.e. snoring, stridor or gurgling.
2. Look at the skin colour:
a) Cyanosis is a sign of severe respiratory distress.
b) Flushing of the skin may indicate an allergic reaction, infection or carbon monoxide poisoning.
3. Count the breathing rate - Slow, normal or fast?
4. Assess whether breathing is regular. If it is irregular it may indicate an underlying problem.
5. Look at the chest movement:
a) Is it deep, shallow, is there symmetrical chest movement?
b) Look for use of accessory muscles & retraction in muscles of the neck.
c) Look for indrawing between & below the ribs on inspiration.
6. Look for any other signs of respiratory distress - pursing lips, nasal flaring or head bobbing in children.
7. Check for a cough - Is it producing phlegm or blood?
8. Can you hear abnormal lung sounds.
9. Assess SpO2.


What are the indications for using PEEP?

Larger than 50kg and status one with any of the following;
Cardiogenic pulmonary oedema
Receiving assisted ventilation
Receiving manual ventilation via mask, LMA or ET tube.


What is the PEEP setting for Asthma?



What is the PEEP setting for Cardiac Arrest?

None - PEEP is not recommended for Cardiac Arrest


What is the PEEP setting for CORD?



Is using PEEP indicated for cardiac arrest?



What are the indications for oxygen administration?

SPO2 less than 94% (cord is exception)
Airway obstruction
Respiratory distress (cord is exception)
Inability to obey commands from TBI
Smoke inhalation
Carbon monoxide poisoning


What is the oxygen flow for nasal prongs?

1 - 4 litres/min


What is the oxygen flow for a simple mask?

6 - 8 litres/min


What is the oxygen flow when using a nebuliser mask?

8 litres/min


What is the oxygen flow when using a reservoir mask?

10 - 15 litres/min


What is the oxygen flow when using a manual ventilation bag?

10 - 15 litres/min


What is LMA short for?

Laryngeal Mask Airway


What are the indications for using an LMA?

1. The airway is poor despite other means tried such as jaw thrust, OPA, NPA.
2. Bag mask ventilation is difficult.
3. The patient needs intubation but no one is available to perform this.
4. In the case of a failed intubation.


What are the two contraindications for using an LMA?

Active vomiting and Trismus (clenched teeth)


Describe the method of inserting the LMA?

1. Deflate the cuff
2. Lubricate the cuff around the tip
3. Extend the patients neck
4. Hold the LMA like a pencil
5. Insert the LMA; hold the tip against the hard palate and follow it down. Maintain pressure against the hard and soft palate to ensure the LMA does not get caught up on airway structures.
6. Inflate the cuff - without holding the tube - and use enough air to obtain a seal.
7. Check LMA placement - listen to lung sounds.
8. Secure LMA with thomas tube holder.


What are the parts of the LMA?

Airway tube
Indicator balloon


What conditions may some patients have which may make using an LMA difficult?

Pulmonary oedema
Pulmonary haemorrhage/contusion


What LMA size would you expect to use on a patient who weighs more than 100kgs

Size 6 (50ml)


What LMA size would you expect to use on a patient who weighs between 70 - 100kg?

Size 5 (40ml)


What LMA size would you expect to use on a patient who weighs between 50 - 70kg?

Size 4 (30ml)


What LMA size would you expect to use on a patient who weighs between 30 - 50kg?

Size 3 (20ml)


What LMA size would you expect to use on a patient who weighs between 10 - 20kg?

Size 2 (10ml)


What LMA size would you expect to use on a patient who is less than 5kg (newborn)?

Size 1 (4ml)


What are the indications for using an NPA?

When the mouth cannot be used to insert an OPA such as in the case of trismus or because patient cannot tolerate an OPA.


How do you use a nasopharyngeal airway?

1. Clear the airway manually.
2. Select size by measuring on angle from nostril to jaw. Also ensure diameter is appropriate size for nostril.
3. Lubricate NPA
4. Select biggest nostril and slowly slide airway down nostril. Push straight back towards the back of the head.
5. Continue inserting until flange s flush with patients nose.
* if bleeding occurs suction airway
6. Check that the patient does not gag


What is OPA short for?

Oropharyngeal Airway


What is the indication for using and OPA?

Used on all patients that do not respond to voice command.
If they do not need it they will cough it out.


How do you use an oropharyngeal airway?

1. Clear the airway manually.
2. Select the airway size by measuring on the angle from the corner of the mouth to the jaw.
3. Hold OPA by the flange
4. Open the patients mouth - cross fingered method.
5. Insert the OPA "upside down", pass the tip past the teeth and slide halfway into the mouth.
6. Rotate the OPA 180 degrees and continue insertion until flange is against the teeth.
* check the patient does not gag


What is the primary purpose of OPA, NPA, LMA's and ET tubes?

To maintain an airway.


Oxygenation - What is it?

The process of providing oxygen to tissue.


Hypoxaemia - What is it?

There is insufficient oxygen content in arterial blood.


Dyspnoea - What is it?

Shortness of breath or Air hunger.


Dyspnoeic - What is it?

Not breathing or able to breath without difficulty.


Oedema - What is it?

An abnormal accumulation of fluid beneath the skin or in cavities of the body.


What is cyanosis?

A blue discoloration of the skin or mucus membranes.


At what SPO2% is cyanosis generally noticeable?



Respiration - Normal rates:

Infants 25-50 per/min.
School age 18-30 per/min.
Adults 12-20 per/min.

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