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Flashcards in Basic Airway Management Deck (23)
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1
Q

Principles

A

There are a number of adjuncts availale for providing airway management. Basic airway management must be established prior to progressing to more invasive procedures

2
Q

Key Points

A
  • Airway management should progress rapidly from the least to most invasive modality
  • Never withhold oxygen when there are signs of hypoxia
  • Ventilation and oxygenation must be assessed independently
3
Q

Airway Maneuvers - Jaw Thrust - anatomy

A

The jaw thrust maneuver is recommended for initial airway control as it has been demonstrated to maximally open the airway

The tongue, soft palate and hypopharyngeal tissues all contribute to upper airway obstruction in unconscious humans

4
Q

Airway Maneuvers - Jaw Thrust - mechanical instructions

A

This “functional obstruction” can be overcome by displacing the tongue anteriorly from the posterior pharyngeal structures as well as displacing the epiglottis anteriorly

The pt’s head should be stabilized in relative alignment with their torso.
The mandible should be displaced anteriorly without extending the pt’s head

5
Q

Airway Maneuvers - Head Tilt Chin Lift

A

If the jaw thrust does not provide an opoen airway and there are no contraindications to cervical spine manipulation
the head tilt chin lift can be added

6
Q

Oral Airway - Oropharyngel Airway (OPA)

A

The OPA is designed to prevent the tongue and other soft tissues from obstructing the glottis.
It is indicated for unresponsive patients who do not have an intact gag relfex

7
Q

OPA - sizing

A
  • Ensure correct size is employed. Measure the OPA from the angle of the jaw to the midline of the mouth
  • Also ensure the mouth has been cleared of secretions or debris
8
Q

OPA - insertion methods

A
  • The traditional method is - insert the OPA upside down or at a 90-dgree angle to avoid catching the tongue, then rotating it into proper position after passing the crest of the tongue
  • OPA may also be inserted using a tongue depressor to displace the tongue while the device is inserted with the bevel posteriorly over the crest of the tongue
9
Q

OPA - issues

A

If an OPA becomes plugged with emesis, blood or other secretions, change out the airway

10
Q

OPA - note

A

Utilization of the OPA does not remove the requirement for manual maneuvers previously described including jaw thrust, positioning the patient and suctioning

11
Q

Nasal Airway - Nasopharyngeal Airway (NPA)

A

The NPA is used to maintain the airway in a semi-responsive or unresponsive patient w/ or w/o an intact gag reflex

12
Q

NPA - cautions

A
  • patients w/ facial or head trauma - but fear of causing injury in the setting of midface trauma has been overemphasized.
  • patients w/ a bleeding disorder or who are on blood thinners, as there can be excessive bleeding compromising the airway
  • patients who have had recent nasal and midface surgery
13
Q

NPA - sizing

A

Measure the NPA from the tip of the nose to the middle of the ear

Also ensure the mouth has been cleared of secretions or debris prior to attempting insertion

14
Q

NPA - insertion

A
  • Lubricate the NPA prior to insertion
  • insert the NPA into the nostril that appears the largest, passing it midline along the floor of the nostril following the natural curvature of the nasal passage which lies in an anterior posterior plane.
15
Q

NPA - issues

A
  • A common error with NPA insertion is to attempt to direct it superiorly, aiming upwards, while inserting - this has the potential to cause trauma to the soft tissue of the nasopharynx
  • DO NOT FORCE the device; slight rotation of the NPA or use of the opposite nostril may be attempted
16
Q

NPA notes

A

Utilization of the NPA does not remove the requirement for manual maneuvers previously described including jaw thrust, positioning the patient and suctioning.

17
Q

Bag Valve Mask (BVM) Ventilation

A

Most patients can be successfully oxygenated and if need be ventilated using good BVM technique
and
adaptinig a staged approach for the Difficult Bag Valve Mask (DBVM) patient

18
Q

BVM - good technique

A
  • well fitting mask
  • properly excuted “EC” grip where the index finger and thumb encircle the base of the mask and the middle, ring and small fingers hook the mandible
19
Q

BVM - good mask seal

A

Key to a successful mask seal is to lift the face into the mask with the EC grip - as opposed to pushing the mask onto the face

“lift and squeeze technique”

20
Q

Difficult Bag Valve Mask - DBVM

A

the pneumonic “BOOTS” should be considered when predicting those pts whome DBVM techniques may need to be employed

21
Q

BOOTS

A
B - Beard
O - Old
O - Obese
T - Toothless
S - Sounds
22
Q

DBVM staged approach

A
  • calling for help early
  • utilizing two or three person BVM techniques
  • changing mask size
  • adding OPA and NPA
  • extending the head ( assuming no C-spine contraindications
  • considering foreign body or cricoid pressure as causing an obstruction
  • placement of an extraglottic deivice and/or intubating (if in scope)
23
Q

Positioning

A

Positioning when the pt does not require ventilatory assistance and there are no other extenuating circumstances
Position the pt 3/4 prone to assist w/ maintaining a clear airway
- Continue to monitor their vital signs and pulse oximetry closely for any sign of respirator embarrassment or change in condition