Basic Airway Management

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Questions and Answers

What is the primary early assessment for airway management in critically ill patients?

Prompting a verbal response (correct)

Listening for respirations

Feeling for airflow

Observing chest movements

Which of the following is NOT a sign of airway obstruction?

Hoarseness of voice

Facial bone fractures

Vomitus in the airway

Excessive coughing (correct)

What is the recommended method for assessing someone who is not fully conscious?

Immediate intubation

Check for carotid pulse

Look-listen-feel approach (correct)

Apply a chin lift

In trauma situations, which technique is preferred for opening the airway?

Chin lift only Signup and view all the answers

Which of the following indicates an adequate ventilation?

Positive verbal response Signup and view all the answers

What should be avoided in polytraumatized patients when attempting to open the airway?

Head tilt Signup and view all the answers

What should be assessed for in someone with suspected airway compromise?

Airflow at the mouth and nose Signup and view all the answers

Which of the following sounds may indicate airway obstruction?

Stridor Signup and view all the answers

In which situation is the oropharyngeal airway contraindicated?

In conscious patients with an active gag reflex Signup and view all the answers

Which airway device is better tolerated among conscious patients?

Nasopharyngeal airway Signup and view all the answers

What is a key reason supraglottic airway devices may be preferred over endotracheal tubes?

They are easier to insert Signup and view all the answers

Which of the following is NOT a type of definitive airway?

Nasopharyngeal airway Signup and view all the answers

What is a common complication of endotracheal intubation?

Esophageal intubation Signup and view all the answers

What does definitive airway provide that enhances protection against aspiration?

Inflatable cuff sealing Signup and view all the answers

What is a potential cause of inadequate ventilation?

Airway obstruction Signup and view all the answers

What can potentially harm a patient during endotracheal intubation?

Tracheal injury Signup and view all the answers

Study Notes

Basic Airway Management

Inadequate oxygenated blood delivery to the brain and vital organs is the leading cause of death in critically ill patients.
Airway and ventilation management is the initial priority in treating critically ill patients.

Airway Assessment

The most crucial initial assessment is to engage the patient in conversation and stimulate a verbal response.
A clear, appropriate verbal response indicates:
- A patent airway
- Adequate ventilation
- Proper brain perfusion
Assessment should include evaluating not only a patent airway but also a protected airway.
Patients with altered mental status are particularly vulnerable to airway compromise and typically necessitate airway management.

Recognition of Airway Obstruction

For unconscious patients or when airway patency is questionable, a look-listen-feel approach is recommended.

Look for:

Vomit or secretions
Facial bone fractures
Facial burns
Neck injuries or hematomas
Abnormal chest and abdominal movement
Increased work of breathing (accessory muscle use)

Listen for:

Snoring
Gurgling
Stridor
Hoarseness of voice

Feel for:

Airflow at the mouth and nose with your cheeks
Avoid close contact with patients if airborne infections are a concern.

Basic Techniques for Opening Airway

Head tilt-chin lift — This manoeuvre involves tilting the head back and lifting the chin to open the airway. Diagrams are included in the slides.
Jaw thrust manoeuvre — The jaw is moved forward to lift the tongue off the back of the throat, opening the airway. Diagrams are included in the slides.
Avoid head tilting in polytraumatized patients.
- In trauma situations, utilize chin lift only, or jaw thrust only, without head tilting.

Basic Adjuncts for Opening Airway

Oropharyngeal airway — This is a curved tube that is inserted into the mouth to keep the tongue from blocking the airway.
- Contraindicated in conscious patients with an active gag reflex to avoid vomiting and aspiration.
- Patients who tolerate oropharyngeal airways often require endotracheal intubation.
Nasopharyngeal airway — A flexible tube inserted through the nose to open the airway.
- Better tolerated by conscious patients.
- Contraindicated in patients with suspected skull base fractures (potential cribriform plate fracture).

Supraglottic Airway Devices

Laryngeal mask airway (LMA) — A device that fits over the larynx and creates a seal to facilitate ventilation.
i-gel supraglottic airway — A device used for airway management.
Supraglottic airway devices are often easier to insert than endotracheal tubes and are considered life-saving alternatives for cases of difficult or failed endotracheal intubation or when proper intubation skills are unavailable.

Definitive Airway

Definition: A tube inserted into the trachea with an inflated cuff placed below the vocal cords.
Types:
- Orotracheal tube
- Nasotracheal tube
- Surgical cricothyroidotomy
- Tracheostomy

Endotracheal Tube

Considered the definitive airway device. It passes through the vocal cords, directly into the trachea.
Most tubes include an inflatable cuff to form a seal between the tube and the trachea, enhancing protection against aspiration.
Only trained personnel with the necessary competency and skill should perform endotracheal intubation.
Complications:
- Failure to intubate
- Esophageal intubation
- Right main bronchus intubation
- Dental trauma
- Laryngeal injury
- Tracheal injury

Management of Ventilation

Definition: The movement of air between the environment and lungs during inspiration and expiration.
Important Factor: Ensuring a patent airway is critical for oxygen delivery, but adequate ventilation is essential for patient benefit.
Potential Causes of Inadequate Ventilation:
- Airway obstruction
- Central nervous system depression
- Chest trauma, particularly with rib fractures
- Cervical spinal cord injury
- Underlying chronic pulmonary diseases
Objective Signs of Inadequate Ventilation:
- Altered mental status or lethargy
- Shallow rapid breathing
- Use of accessory muscles
- Diminished chest expansion (detected through inspection and palpation)
- Diminished breath sounds (detected by auscultation)
- Low oxygen saturation
Improving Ventilation Recognition:
- Regularly monitor respiratory rate and work of breathing
- Obtain arterial or venous blood gas samples
- Utilize capnography (if available)
Management Techniques:
- Intubation of trachea and connection to mechanical ventilation is the most effective method.
- Prior to intubation, utilize the Bag-Valve-Mask (BVM) technique for ventilatory support.
  - Single-person BVM technique methods
  - Two-person BVM technique methods

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Description

This quiz covers the essential principles of airway management in critically ill patients. It emphasizes the importance of airway assessment, recognition of airway obstruction, and patient communication. Enhance your understanding of managing airways effectively in emergency situations.