Airway Management Fundamentals

Overview of Airway Management

• A patent airway is essential for oxygenation
• Failure to manage the airway is a leading cause of preventable prehospital deaths
• Critical to reassess the airway and use basic techniques properly without rushing to advanced methods
• Brain damage can start in around 6 minutes without oxygen

Respiratory System Function

• Oxygen in / CO2 out
• Disruption of function leads to organ failure, especially in the brain

Anatomy of the Upper Airway

• The upper airway ends at the vocal cords
• Functions to warm, filter, and humidify air

Nasopharynx

• The nasopharynx is lined with ciliated mucosa
• Turbinates increase surface area to improve filtration
• The nasal septum divides passageways
• Sinus fractures can cause cerebrospinal fluid (CSF) leaks

Oropharynx

• Bound by the palates, cheeks, and tongue
• The tongue is a common cause of anatomical obstruction
• The hard and soft palate separates the oropharynx and nasopharynx
• Adenoids and tonsils can become obstructions through infection
• The epiglottis blocks the airway when swallowing, and is the narrowest portion
• The vallecula is a key landmark for intubation

Larynx

• The larynx marks the transition to the lower airway
• The thyroid cartilage is also known as the Adam's apple
• The cricoid cartilage is the only full ring
• The cricothyroid membrane is the site for emergency airway access (cricothyrotomy)
• The glottis is the narrowest part of the adult airway, and is located between the vocal cords
• The arytenoid cartilages help with vocal cord movement and serves as an intubation landmark
• The pyriform fossae are a site of misplacement during intubation
• Laryngospasm is a spasmodic closure of vocal cords that can fully block the airway

Clinical Scenario

• Signs of hypoxia include pallor, diaphoresis, tachypnea, tachycardia, accessory muscle use, and intercostal retractions
• Immediate management involves 100% oxygen via non-rebreather and preparation for ventilation if breathing worsens
• A useful method for asking history questions is using OPQRST:
  • Onset & pattern (acute/chronic)
  • Provoking/relieving factors (e.g., can they lie flat?)
  • Severity perception
  • Related conditions like asthma, COPD, heart failure (HF), or pneumonia

Hot Exam Tips

• Mastery of basic and advanced airway interventions is crucial
• Anatomical landmarks for intubation must be identifiable
• Clinical signs of airway compromise must be understood
• Application of OPQRST in respiratory cases is necessary
• Focus understanding differences in airway structure and management in adults vs. pediatrics

Functions of the Lower Airway

• Involves gas exchange: oxygen in, carbon dioxide out
• The lower airway extends externally from C4 to the xiphoid, and internally from the glottis to the pulmonary capillary membrane

Trachea

• The trachea is 10-12 cm in length
• It starts below the cricoid cartilage
• It ends at the carina (T5-T6 level)
• Composed of C-shaped cartilaginous rings

Bronchi

• The right main bronchus is more likely to be the site of ET tube misplacement because it is shorter and straighter
• The division of the respiratory system goes from bronchi to bronchioles to alveolar ducts to alveoli

Lungs

• The right lung has 3 lobes
• The left lung has 2 lobes
• Visceral pleura covers the lungs
• Parietal pleura lines the thoracic cavity
• Pleural fluid reduces friction

Alveoli

• Alveoli are the primary site of gas exchange
• Lined with surfactant to reduce surface tension
• Atelectasis is the collapse of alveoli, which happens from loss of surfactant or blockage

Total Lung Capacity

• Total Lung Capacity (TLC) is about 6 L in adult males
• Not all of TLC is used in normal breathing
• Most gas exchange occurs in alveoli
• A small amount of gas exchange occurs in alveolar ducts and terminal bronchioles

Tidal Volume

• Tidal Volume (VT) refers to the depth of breathing
• Normal Tidal Volume:
  • 5-7 mL/kg in adult males
  • 6-8 mL/kg in infants and children
• One-third of the tidal volume stays in the dead space, and does not participate in the gas exchange
• The inspiratory reserve volume is approximately 3,000 mL

Dead Space

• Anatomical dead space includes the trachea and large bronchi (approximately 150 mL)
• Physiological dead space is due to disease (e.g., atelectasis)

Alveolar Volume

• Alveolar volume is the tidal volume minus dead space
• Approximately 350 mL of air reaches the alveoli for gas exchange

Minute Volume

• Minute volume is the amount of air moved per minute
• Minute Volume = Tidal Volume × Respiratory Rate
• Minute alveolar volume (VA) = (VT – dead space) × RR
• Increased RR or VT results in increased minute volume
• Fast breathing often leads to shallow breathing, reducing alveolar volume

Functional Residual Capacity

• Functional Residual Capacity is the volume left in lungs after normal exhalation
• The Expiratory Reserve Volume (ERV) is approximately 1,200 mL
• The Residual Volume (RV) is approximately 1,200 mL

Fraction of Inspired Oxygen

• Fraction of Inspired Oxygen (FiO2) is the percentage of oxygen in air
• Room air has an FiO2 of 0.21 (21%)
• FiO2 increases with supplemental oxygen

Quick Memorization Phrases

• Primary respiratory drive is triggered by high CO2, sensed by pH in CSF (central chemoreceptors)
• Dead space = Air that doesn't reach alveoli, causing no gas exchange
• Alveolar volume = Tidal volume – dead space (approximately 350 mL)
• Minute volume = RR × VT
• Increased RR or VT results in increased ventilation
• Anatomic dead space includes the trachea and bronchi
• Physiologic dead space includes diseased alveoli
• FiO2 increases with oxygen therapy

Definitions

• External respiration: Gas exchange between alveoli and pulmonary capillaries
• Internal respiration: Gas exchange between systemic capillaries and body tissues
• Dead space: Areas of airway not participating in gas exchange
• Minute volume (VM): Total air moved in/out of lungs per minute
• Tidal volume (VT): Volume of air per breath Residual volume (RV): Air remaining after maximum exhalation

Overview of Ventilation

• Ventilation is the physical movement of air into and out of the lungs
• It is comprised of 2 Phases:
  • Inspiration: active process
  • Expiration: passive process
• The ventilation cycle consists of 1/3 inspiration and 2/3 expiration

Regulation of Ventilation

• Primary regulation is controlled by pH of CSF
  • This is linked to CO2 levels in the blood.
  • Increased CO2 leads to decreased pH which leads to increased ventilation
• Neural Control
  • Originates from pons and medulla (brainstem)
  • Phrenic nerve affects the diaphragm
  • Intercostal nerve affects the intercostal muscles
  • Respiratory rhythmicity center sets respiratory rate
  • Hering-Breuer reflex prevents lung overinflation
  • Apneustic center stimulates inspiration
  • Pneumotaxic center inhibits inspiration
• Chemical Control includes central chemoreceptors in the medulla
  • They detect pH of CSF
  • Peripheral chemoreceptors in the carotid/aortic bodies detect O2/CO2 levels
• The primary drive is PaCO2 regulation
• The backup system is Hypoxic drive, which occurs in COPD or respiratory failure. The other influences include body tempurature, medications, hypoxia, acidosis, and metabolic rate

Mechanics of Ventilation

• Inhalation
  • This is an active process where the diaphragm and intercostals contract
  • Volume increases, leading to decreased pressure and air flows in
  • This is knowns as negative pressure ventilation
• Exhalation
  • This is a passive process where muscles relax and lungs recoil
  • Volume decreases leading to increased pressure, causing air to flow out

Review of Ventilation

Ventilation = Inspiration (1/3) + Expiration (2/3) - Regulated by CSF pH, which reflects CO2 and provides major control for breathing - Neural control is through the medulla + pons and is affected by phrenic/intercostal nerves - The Hering-Breuer reflex prevents overinflation - Chemoreceptors in the central (CSF pH) and peripheral (PaCO2, O2) systems affect ventilation - The primary drive is CO2 regulation and the backup drive is hypoxic - Inhalation is active and exhalation is passive - Negative pressure pulls air into lungs

Overview of Respiration

• Respiration = gas exchange: O2 in, CO2 out
• External respiration between lungs and blood
• Internal respiration between blood and tissues
• Diffusion = movement of gas from high to low concentration
• Oxygen transport:
  • About 97% is bound to hemoglobin
  • Measured by pulse oximeter (SpO2)
• CO2 transport primarily occurs as bicarbonate ions (HCO3-)

Causes of Decreased Oxygen Concentration

• Low O2 availability or transport
  • High altitudes / carbon monoxide exposure
  • Severe bleeding
  • Anemia (decreased RBCs leads to decreased O2-carrying capacity)
• Reduced gas exchange surface
  • Flail chest, pneumothorax, hemothorax, diaphragm injury
  • Intrapulmonary shunting is when blood bypasses alveoli without O2 exchange
• Decreased mechanical effort
  • Chest pain leads to shallow breathing
  • Traumatic asphyxia leads to hypoventilation
• Medical conditions
  • COPD, pneumonia, pulmonary edema
  • Conditions that cause alveoli to become nonfunctional

Abnormal CO2 Concentrations

• CO2 production depends on metabolism
• Increased metabolic rate results in increased CO2
• Decreased metabolic rate results in decreased CO2
• Hypoventilation happens when CO2 builds up faster than it can be exhaled, leading to hypercapnia (increased CO2 in blood)
• Hyperventilation happens when CO2 is eliminated faster than produced, leading to hypocapnia (decreased CO2 in blood)

Minute Volume

• Minute volume = Tidal volume × Respiratory rate
• Decreased minute volume leads to less CO2 elimination and hypercapnia

Dalton's Law

• Total pressure is the sum of partial pressures of individual gases: O2, CO2, nitrogen, and water vapor

Quick Recap for Rapid Revision

• Respiration = O2 in + CO2 out
  • External respiration = lungs
  • Internal respiration = tissues
• O2 is mostly bound to hemoglobin, measured by SpO2
• CO2 is mostly transported as bicarbonate
• Low oxygen can be caused by anemia, trauma (flail chest, pneumo), shallow breathing, pneumonia CO2 imbalance
  • Hypoventilation = hypercapnia
  • Hyperventilation = hypocapnia
• Dalton's Law: gas pressure = sum of each gas's partial pressure

Airway Evaluation Parameters

• Normal adult RR: 12-20 breaths/min (at rest, effortless)
• Effortless, regular breathing pattern indicates adequate ventilation
• Tripod or semi-Fowler's positioning is a compensatory response to respiratory distress

Recognition of Airway Problems

• Patent airway is indicated if the patient can talk normally (but continue monitoring)
• Watch for signs of distress: abnormal rate, shallow depth, irregular rhythm
• Hypoxemia progresses to hypoxia and then to anoxia if untreated
• Evaluation methods include:
  • Visual assessment through observation of accessory muscles, nasal flaring, cyanosis, and comparing chest rise on each side
  • Auscultation to listen for bilateral, clear breath sounds (abnormal sounds may indicate obstruction)
  • Palpation to check for pulsus paradoxus (decreased SBP >10 mmHg during inhalation may indicate severe distress)
• Protective reflexes: cough, gag, sneeze, hiccup are important for airway protection (loss of protective reflexes indicates a risk of aspiration)

Diagnostic Testing

• Pulse oximetry:
  • Normal SpO2: >95%
  • SpO2 <90% in the presence of respiratory distress = emergency
  • COHb/metHb can cause false normal readings (pulse ox cannot differentiate)
  • Watch for erroneous readings from nail polish, motion, poor perfusion, or bright light
• Peak expiratory flow:
  • Improving flow indicates a response to treatment
  • Dropping flow indicates early deterioration ETCO2 Monitoring:
  • Capnography (graph + number) is the best tool for monitoring ventilation
  • The normal waveform has 4 phases
  • Changes in shape can provide clues (e.g., shark-fin shape indicates bronchospasm)
• ABG: Gold standard for respiratory status (but done in hospital)
• Use pulse ox + capnography together for the most accurate picture in pre-hospital setting

Quick Review

• RR + Rhythm + Effort = Key for airway assessment
• TRI-pod = Trouble Breathing
• Cough/Gag Reflex = Guardian of the lower airway
• Shark-Fin Capnograph = Bronchospasm (e.g., asthma/COPD)

Positioning the Patient

• Supine position is ideal for airway access, assessment, and intervention
• Unresponsive prone patient must be log rolled into supine position
• Recovery position (left lateral recumbent) is useful for non-trauma, unresponsive, spontaneous breathing patients who can maintain their own airway

Manual Airway Manoeuvres

• The tongue is a common cause of obstruction in unresponsive patients: it falls back against the pharynx

Head Tilt-Chin Lift

• Safe to use in patients where spinal injury is not suspected, and if the patient is unresponsive with no airway protection
• Avoid if suspected cervical spine injury
• Advantage: No tools needed, simple and quick,
• Disadvantage: Doesn't protect from aspiration and is risky in spinal injury To perform the maneuver:
• One hand on forehead (tilt back)
• Fingers under bony chin (lift chin)
• Don't compress soft tissue or close the mouth completely

Jaw-Thrust Manoeuvre

• Use when suspected cervical spine injury + unresponsive
• Avoid when the patient is responsive or resisting
• Advantage: Safe for spinal injuries
• Disadvantage: Fatiguing, hard with BVM, needs 2nd rescuer, no aspiration protection To perform the maneuver:
• Place thumbs on cheekbones (zygomatic arches), fingers behind jaw angle
• Lift jaw forward while maintaining neck alignment

Jaw-Thrust with Head Tilt

• Similar to head tilt-chin lift, but initiated with jaw-thrust hand position
• Only use when no spinal concern
• Still hard to maintain and doesn't protect from aspiration

Tongue-Jaw Lift

• Purpose: For suctioning or inserting OPA (not ventilation)
• Technique: One hand on forehead, other hand lifts jaw using index finger inside mouth

Review of Airway Management

• Unresponsive, no trauma: Head tilt-chin lift
• Unresponsive, suspected spinal trauma: Jaw-thrust
• Responsive patient: No manual airway unless needed
• Recovery position to use if airway is patent and no trauma
• The tongue = #1 obstruction in unconscious patients
• Manual maneuvers don't protect against aspiration
• All maneuvers are temporary until airway adjuncts are placed or a definitive airway is secured

Airway Obstruction

• Causes of airway obstruction includes infection/allergic reaction:
  • Do not treat as foreign body (blind sweeps are contraindicated
• Tongue obstruction is common in patients with decreased LOC
  • Causes snoring (partial) or silent (complete) obstruction
  • Fixed with head-tilt-chin lift or jaw-thrust
• Foreign Body obstruction:
  • Risk increases with dentures, alcohol, and decreased airway reflexes
  • Signs: choking, gagging, stridor, aphonia/dysphonia
  • Check if they're moving air to guide treatment
• Laryngeal Spasm/Edema:
  • Can cause full airway closure through spasmodic vocal cords
  • Often happens after intubation/extubation trauma
  • Treat with PPV with BVM, jaw thrust
• Laryngeal Injury:
  • Fracture = decreased airway size due to edema/loss of tone
  • May need advanced airway management
• Aspiration:
  • Increases mortality (blood, fluids)
  • Leads to bronchiolar damage, infection, decreased ventilation
  • Always have suction ready

Recognizing Airway Obstruction

• Mild obstruction
  • Effective cough, noisy breathing
  • Don't intervene, but encourage coughing
• Severe
  • Can't speak/breathe/cough
  • Universal sign of hands at throat
  • Cyanosis, stridor, panic

Emergency Medical Care for Airway Obstruction

For a Responsive Patient:

• Ask: "Are you choking?"
  • If yes and severe, use abdominal thrusts (unless pregnant/obese, then use chest thrusts) For an Unresponsive Patient:

1. Open airway and check the mouth
2. Attempt ventilation
3. If ventilation fails, reopen the airway and try again
4. If still not effective, start compressions
5. Repeat 30 compressions + check airway + ventilation

Special Techniques by Age/Consciousness

• Responsive Adult/Child: Abdominal Thrusts
• Unresponsive Adult/Child: Open Airway → Ventilate → Compressions (30:2 or 15:2)
• Responsive Infant: 5 back slaps + 5 chest thrusts
• Unresponsive Infant: Slight neck extension → Ventilate → Compressions

Advanced Skills

• Magill Forceps: Use only if object is visible during direct laryngoscopy
• Practice steps and indications Cause, Signs, and Management of Different Airway Compromises:
• Tongue: Snoring or silent obstruction managed with head tilt-chin lift or jaw-thrust
• Foreign Body: Choking, stridor, aphonia managed with cough if mild, or Heimlich if severe
• Laryngeal Spasm: Complete occlusion post-intubation treat with PPV or jaw thrust
• Laryngeal Injury: Trauma and swelling is managed through advanced airway techniques

Key Points – Suctioning

• Gurgling sounds require immediate suction
• Secretions like vomit, blood, or mucus in the mouth must be suctioned before ventilating
• Ventilation of secretions can cause aspiration or obstruction

Suction Equipment

• Fixed Unit: Powered by engine manifold (ambulance)
• Portable Unit: Battery or hand-powered
• It must have adjustable suction for pediatric patients, and be powerful enough for oropharynx
• Adjustable suction (for kids), powerful enough for oropharynx, checked at start of each shift Supplies:
  • Wide, nonkinking tubing
  • Rigid (Yankauer) & soft (French) catheters
  • Nonbreakable collection bottle
  • Water for rinsing Catheters:
  • Yankauer (rigid): Best for adults, but is is also safe for kids
  • French (soft): For nose, liquid secretions, tracheal tube, or if rigid is not usable

Suctioning Technique

• Always pre-oxygenate before suctioning
  • Helps remove oxygen
• Time Limit
  • A maximum of 15 seconds for adults
  • Less than 15 seconds for children/infants

Inserting Catheter

• Measure from corner of mouth to earlobe
• Utilize a cross-finger technique or tongue-jaw lift
• No suction while inserting; apply suction in circular motion on withdrawal
• Reoxygenate between attempts if needed

Soft-tip catheter Insertion Procedure

• Lubricate before nasopharynx suction
• Insert gently, apply suction only while withdrawing
• Never insert past the base of the tongue

High-Yield Exam Triggers for Suction

• "Patient is gurgling”: immediate suction
• "Vomiting + unconscious": suction before airway/ventilation
• "How long to suction?": 15 seconds for adult
• "How to measure?": Mouth corner to earlobe
• "Yankauer us. French": rigid for pharynx, soft for nose, secretions, tracheal tubes

Key Points – Airway Adjuncts

• Artificial airway does not replace proper head positioning
• Use suction first if blood/secretions present
• Insert airway adjuncts only after clearing the airway

Oropharyngeal Airway

• It is a hard, curved plastic device
• OPA keeps the tongue from blocking the airway, and improves bag-mask ventilation

Indications for OPA insertion

• Unresponsive patients without gag reflex Contraindications:
  • Responsive patients or those with gag reflex Complications:
  • Gagging can result in vomiting and aspiration
  • Dental/pharyngeal trauma if inserted roughly
  • Improper sizing/placement can worsen obstruction

Sizing the OPA

• Measure from corner of mouth to earlobe Insertion Techniques:

1. Standard (180° Rotation):
   • Insert upside down and rotate 180° once halfway in
2. Alternate (90° Rotation):
   • Use tongue blade to keep tongue forward
   • Insert sideways, rotate 90°, remove blade as you place

Useful Tips

• If patient gags during suction, switch to NPA
• Always clear the mouth before inserting the OPA

Nasopharyngeal Airway

• NPA is a soft rubber tube, inserted through the nose to pharynx, and is tolerated in patients with gag reflex but decreased LOC
• Indications:
  • Altered mental status with gag reflex
  • Can be used in responsive patients if tolerated Contraindications:
  • Suspected skull/facial fracture
  • Active nose trauma or bleeding Complications:
  • Epistaxis (nosebleed)
  • Poor placement = obstruction or patient intolerance

Sizing the NPA

• Measure: Tip of nostril to angle of jaw
• Diameter should be approximately be the same size as the patient's little finger

NPA Insertion Steps

1. Lubricate with water-soluble gel
2. Insert into larger nostril, bevel toward septum
3. Follow nasal floor, do not force
4. Flange should rest on nostril opening Triggers to Know for the Exam:

• Responsive and no gag reflexes use OPA
• Responsive or gag reflex is avoidance criteria to use OPA, instead consider NPA
• Always use water based lubricant, never oil based

Review

• "Unresponsive, no gag" indicates the use of an OPA
• "Responsive or gag reflex" indicates is a time to avoid an OPA, consider NPA instead
• "Nose trauma or skull fracture suspected" always indicates do NOT use NPA
• the correct size OPA can be determined by measuring from the "Corner of mouth" to earlobe"
• the correct size NPA can be determined by measuring trom the "Nostril → angle of jaw"
• Correct OPA can be achieved by "using 180° or 90° rotation with tongue blade"
• “Patient gags during OPA" means "Remove, then try NPA instead"

Overview

• Indications: Respiratory distress, suspected/documented hypoxemia
• Always use precaution: Avoid excessive O2 in well-oxygenated patients, they risk hyperoxia.
• Purpose: Supports compensatory mechanisms during distress/shock
• Important: Delivery method must match patient's ventilation status.

Oxygen Sources

• Types of cylinder:
  • D cylinder: 350 L, portable
  • E cylinder: 625 L, common mid-size
  • M cylinder: 3,450 L, onboard main supply
• Important to replace cylinder at 200 psi
• Cylinders are color varies, but is often marked green/silver, it needs labeling for medical oxygen use.
• Hydrostatic test: every 10 years
• Saftey Tips:
  • Handle with care! Explosions are possible
  • Zero tolerance for smoke, or high fire potential
  • Avoid grease/oil
  • Expect high air flow

Reminders for Oxygen safety:

• Must have high pressure = Explosions could occur.
• Supports combustion, is fire prone be sure to Avoid oil/grease/smoking.
• Safely stowing away tanks and cylinders
• When you want to open valve do not: Lean over or stand in front of the valve
• When storing its best to store in a cool, ventilated area.
• Liquid Oxygen
  • Stored as liquid, releases gas form as it warms.
  • High use due to needing large volumes.
• Pressurized Regulators
  • Transfers gas between tanks with high-pressure regulators
  • Lowers pressure to ~50 psi using Therapy regulators
• Flowmeters: Float ball and must remain upright for pressure-compensated:; Bourdon-gauge is but inaccurate high volumes

Quick Memory Tricks for Cylinder Facts

• ”DO ME FLOW” – Cylinder Facts
  • D cylinder, Medical, E cylinder, Flowmeter, Liters, Oxygen, Watch the pressure
• ”FIRE HAZE” – Safety Tips
  • High explosion Risks, Inspection, Regulator alignment, every 10 yrs, Zero grease/oil, High flow, Always avoid smoke

Important Oxygen Masks and Delivery Devices

1. Nonrebreathing Mask

• Preferred for high-concentration oxygen in spontaneously breathing patients
• Rate must be at 12-15 L/min. - Delivers ~90% oxygen - Reservoir bag must be filled before using - Avoid exhaled air re-entering bag by using One-way valve - Should not use if pt is having poor effort, or non breathing

2. Nasal Cannula
   • Better use for low to moderate needs.
   • Rate starts at 1-6 L/min. Delivers 24%-44% oxygen
   • Long term will require humidifier set ups.
   • Must breath through mouth to use, should not use if severe hypoxia
3. Simple Face Mask
   • 10 L flow
   • Delivers 40%-60% oxygen
   • Room temp intake via ports that is on the side
   • Rarely use
   • Less precise
4. Venturi Mask
   • Precise and Best for COPD rates being 24%, 28%, 35%, 40%, 50%. in O2 deliverly

• Good use for travel
  • Combines with room oxygen, will

5. Hi-Ox Mask
   • Protects from being inhaled by pathogen, modified with filtration system
   • Similar to high 02 to NBR or NBR in high infection area.
6. Small-Volume Nebulizer
   • oxygen flow with medicines that are used
   • Delivers 3-5 ml fluid + oxygen

• Medications.

Review for Oxygen Delivery

• Always Remember know what style will match the pt (i.e COPD with Hi-Ox)
• Device and 02 flow

Review Oxygen Delivery - Review -

• Remember humidification, its long term not short term needed - long-term nasal cannula.
• Be sharp on Venturi masks (precise O2%) - Great for COPD. pts.

Breathing Management

• Artificial ventilation and oxygen is needed if you have Breathing pt, with apnea / inadequate volume, is important to use. Is slow or fast.
• Always apply ventilation(PPV).
• Rate being 15L / min helps with breathing
• The value prevents any contact with patient’s air that exanimated.
• The challenge can hyperinflation and hyperventilation (distention caused).

Oxygen flow

• O2.flow Rate of 15 L with over 100 or nearly 100% by Rate of 15 helps
• Poor effective and seals can be difficult. Inadequate is high
• BVM and 02 rate is needed.

BWM (Review)

• The person does not the mask while other person squeeze
• Important for 2 people. To get excellent and high seals one holds seal while other squeezed.
• Indication - In pt as poor ventilation - In some spinal settings
• Avoid high rates of patients that can't tolerate and hyperinflate.
• The best way to preform and the person over the other.

PPV (Review)

• PPV is nonvassive when it comes to 02 not being for someone in apnea.
• Mech - Exchange improves while airway is pressure and avoids collapsing
• RR and Sp02 are very important when it comes to distress with O2 and post drowning.

Contraindications

:

• The patient cannot be able to Unresponsive/inability to follow commands
• Respiratory/cardiac arrest
• Vomiting/GI surgery
• Facial trauma, pneumothorax
• Hypotension, tracheostomy

Review

• FIO2: Usually fixed (30-35%)
• Complications: Claustrophobia and lower venous returns due pressures

Important study quizes and key info

• Make sure you understand quizes and information pertaining to artificial help and CPAP. As well as the rates of liters on ventilation. As they are all important

Reminders for Ventilation help

Q1: When should a person receive artificial help?

• A: Only when breathing irregular Q2: What's the oxygen concentration delivered via BVM with reservoir at 15 L/min?
• A: Almost 100%. Q3: Key advantage of two-person:
• A: Better seal and a higher higher volume

Q4: Main indication and contraindication for CPAP?

• A: Indication with alert respiratory distress
  • C: Avoid pt with not being alert

Q5: CPAP complications to monitor?

• A: Intolerant patients with BP issues

Review for indication with Airway help / Ventilation

• Never assume that is its breathing or normal
• Pay close attention to if they are slow or fast
• Shallow and non-consistent air per breath is bad
• Irreagular Pattern with fatigue
• Assess O2,Mental health and overall poor exhanges
• The phrase to help is effort off is good

Important facts regarding air way

• Never rush into advanced airway unless:

1. Airway not patent
2. Inadequate oxygenation/ventilation

• Predicting difficult airway: The biggest error one can do if fails to estimate what could occur
• MOANS (BVM difficulty):
• Mask seal, Obesity, Aged, No teeth, Stiff lungs
• LEMON (intubation difficulty):
• Look, Evaluate 3-3-2 rule, Mallampati, Obstruction, Neck mobility
• Cormack-Lehane Classification: Grades laryngoscopic view
• Alway make sure you have an alt measure (e.g., supraglottic airway, BVM)

We always use prediction tool because?

• Never ignore the difficultes.
  • The biggest mistake is failing to estimate a hard airway to avoid failures with airway
• Remember asses as much as one can

Predicts issues with with ventilation as you BVM

MOANS you can count one to better for BVM

• • The different factors and reasoning why they do

• Why MOANS is used

• A big mask with with obstruction requires Extra tissue

• less tension if the older age

The meaning of MOANS:

MOANS is to help assess the

• is a is to hard to seal - The facial hair can be a issue
• The body and weight on the chest or lungs
• Older Pt that has loss of the lungs or strength
  • missing teeth

Always remember LOREM with all measurements

• LEMON – Predicts intubation difficulty:

Facial is hurt beard is huge tongue is Bad to breath is what the evaluate is over and over

• Tongue issue and small head

What does lemon measure - what is important

• The components being*

• Look at the pt for facial truma

• Evaluate*

• What measurement is the throat The biggest issue obstruction where the head can't moveright

Know to use all to help improve

• video laryngoscopy or supraglottic

A note of all ratings / measurements

• Grades laryngoscopic and Cormack-Lehane ratings**

• All grades help assess where the chords visibility

• And is used

The reason to help improve on is to lower hypoxia Remember how predict measure and preform these

Always have memory for this notes

• Always prepare (MOONS for BVM as well LEMONE for 02 delerity)
• All messurments (use as back up) with this
• All pts Hypotxia, this is to keep undercontroll.
• The pt will breath when tubed to their cords and seal
  • Larin scope as an alt to cords and helps a lot with tools
• The steps has been completed
• Important
  • all the items they use Pilot balloon, Murphy's eye

All tube measurements are:

• 7.9 - 8 women for -100 women -25 - 4 for children
• pinky as the right measurement and all types in the tools
• Miller
• goes uderr the epigladice
• Macintosh will always follow these rules easy
• Helps all shape as magil and is removed with out fail These are all important notes to remember when pre forming

Orotacheal Intubation

• Always be consitdent

• If you have cardiac issues - use the method

• never have gag issues or view issues - look around

• Always look to preoxygenate, look side to side for any issues.

Always be careful - Miller - or Macro Mac

• or any issue
• burp them quickly and remove A lot can occur when setting up

All tubes and setting up

• Cam assists with tubes
• insert tubes to cords Inflate and listen for bubbles that can esphagus
• If its broncus or tubes side
• Always try and use
• A bulb that collapsed the the placement

Its about making the Tube

• Being harder to insert
• Use comersall devices is amazing Blind the tech you can find tips Can be with finger and open to u or shape To avoid injury use commercial and rarely

Always remove Tracheal after being done,

• its what we do
• To re insert
• Always keep a lot of air

What might to face with a tube To remove as well what it is and why

Supra

• You have Curved tube with 2 cuffs (pharyngeal + distal ventil)
• Some have a Distal end thats opened or Distal end thats closed
• Most is alternative for intubation fills or does have a gag reflex
• Be warned as that Larygospams or stomach or improper insertions can occur
• Step: insert and inflate and test

-All the steps What to use and expect

The use and step to work

i gel tools for LMA -

• Design: Its flexible and helps as it fills around an airway
• The tools have backup for when you loose pt

You can always have:

Open back or close, you can not have reflex pt or hiatol herina.

• easy access, less time and effort

But

Never stomach back up that can risk all or stomach full

iGel

• They dont inflate an it helps with a great airways with seal

• Waveform can tell how preformed it work

• PPE - All steps we show, follow and use

These are just quick notes, quick reminders to make with the material used

• All items can be used and they are very beneficial.

Final Notes For A Air Way

: One is only to use and apply Cricothyrotomy if the methods do not pass : The methods are either :

• Opened by a Cricothyrotomy being the surgical Or they are catheter based : Nearby blood vessels to note: Always be aware of some near vessel around
• Superior vessel
• Cartoid Vessel

Important Notes / Cricothyrotomy being the Opened type

: Indications :

• is one of the last measure when the line
• Never to be used when there a upper blockage in anyway like for bodies and swells.
• when pt have issues from any traun or head.
• Never to those without training , children, or no airway
• Important to have manipulations, or quicks is needed Easy to manipulate in these measures. There always bleeding but controllable. : The biggest disadvantage: In the event there pt has muscls issues or in kid is difficult : Complications that include:
• Bleed, have airway damaged, tube out and infect

Final Note : Steps to help

• Test test test always.

• Always vertical the cut

• Add and preform tube Check all is a go: Always add all measures in terms of tubes with equipment.

All info is important and is beneficial.

Remember to have steps and quick response preformed

With correct reasoning.

• Complication you expect
• All issues that will follow

Everything must and will be reviewed to make to best come in mind As well there a good use for what can or can not be achieved and what you are to fix or to find.