Respiratory Care Therapeutics: Establishing an Artificial Airway

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Questions and Answers

Why is establishing an artificial airway and maintaining respiration crucial?

To prevent respiratory failure

To maintain a healthy heart rate

To ensure proper breathing techniques

Because all cells will eventually die if deprived of oxygen (correct)

What is the Glottis in the context of the airway?

The lungs

The trachea

The area between the vocal cords (correct)

The upper airway

What is the primary function of an artificial airway?

To provide an opening for ventilation (correct)

To regulate breathing patterns

To provide oxygen therapy

To monitor respiratory rate

What is the main difference between orotracheal and nasotracheal intubation?

The route of insertion into the trachea Signup and view all the answers

What is the primary indication for establishing an artificial airway?

Relief of airway obstruction Signup and view all the answers

What is the term for the process of placing an artificial airway into the trachea?

Intubation Signup and view all the answers

What are the two main categories of artificial airways?

Pharyngeal and tracheal airways Signup and view all the answers

What is the term for the tube or tube-like device inserted through the nose, mouth, or trachea to provide an opening for ventilation?

Artificial airway Signup and view all the answers

What is the correct way to insert an oropharyngeal airway?

Hold the airway upside down and insert it in the patient's mouth, then rotate it 180° until the flange rests on the patient's lips. Signup and view all the answers

What is a contraindication for using an oropharyngeal airway?

Intact gag reflex Signup and view all the answers

What is the purpose of using an oropharyngeal airway?

To maintain a patent airway and prevent tongue bite Signup and view all the answers

What is a hazard of using an oropharyngeal airway?

All of the above Signup and view all the answers

What is the correct size of an oropharyngeal airway measured from?

The corner of the mouth to the angle of the jaw Signup and view all the answers

What is an advantage of using an oropharyngeal airway?

It is simple to use and cheap Signup and view all the answers

What is a part of the oropharyngeal airway?

Flange, bite portion, and air channel Signup and view all the answers

In which type of patient can an oropharyngeal airway be used?

Unconscious patient Signup and view all the answers

What is the primary purpose of using a tongue depressor during the establishment of an artificial airway?

To displace the tongue away from the roof of the mouth Signup and view all the answers

What is the advantage of using a nasopharyngeal airway in patients with intact gag reflex?

It is better tolerated by conscious patients Signup and view all the answers

What is the measurement used to determine the proper size of a nasopharyngeal airway?

From the tip of the nose to the patient's earlobe Signup and view all the answers

What is one of the contraindications of using a nasopharyngeal airway?

Anticoagulation Signup and view all the answers

What is another use of a nasopharyngeal airway besides maintaining airway in patients with intact gag reflex?

As a guide for a fiberscope or nasogastric tube Signup and view all the answers

What is the part of the nasopharyngeal airway that comes into contact with the patient's nose?

Flange Signup and view all the answers

In what situation would a nasopharyngeal airway be used instead of an oral airway?

When the patient has intact airway reflexes Signup and view all the answers

What is one of the advantages of using a nasopharyngeal airway?

It can be used when the mouth cannot be opened Signup and view all the answers

What is the purpose of the 3-3-2 rule in LEMON Assessment?

To assess the ease of access to the airway Signup and view all the answers

Which of the following conditions is associated with difficult intubation?

Temporomandibular joint dysfunction Signup and view all the answers

What is the significance of the distance between the mentum and the hyoid bone in the 3-3-2 rule?

It estimates the volume of the submandibular space Signup and view all the answers

What is the purpose of evaluating mouth opening in the 3-3-2 rule?

To facilitate insertion of the laryngoscope Signup and view all the answers

What is the implication of a patient being able to open their mouth to admit three of their own fingers?

The patient has a normal airway anatomy Signup and view all the answers

Which of the following is NOT a condition associated with difficult intubation?

Hypertension Signup and view all the answers

What is the significance of the 3-3-2 rule in airway assessment?

It predicts the success of direct laryngoscopy Signup and view all the answers

Which of the following is a condition associated with difficult intubation?

Burn scar at face and neck Signup and view all the answers

What is the preferred method for establishing an artificial airway in patients with maxillofacial injuries?

Nasotracheal intubation Signup and view all the answers

What is the purpose of applying a mixture of 0.25% phenylephrine and 3% lidocaine to the nasal mucosa?

To provide local anesthesia and vasoconstriction of the nasal passage Signup and view all the answers

What is the primary consideration for choosing the Head Tilt–Chin Lift Maneuver over the Jaw-Thrust Maneuver?

Suspected cervical spine injury Signup and view all the answers

What is the purpose of lubricating the endotracheal tube with water-soluble gel?

To aid passage of the tube Signup and view all the answers

What is the correct positioning for the Jaw-Thrust Maneuver?

Kneeling above the patient's head Signup and view all the answers

What is the purpose of using direct visualization for nasotracheal intubation?

To visualize the trachea Signup and view all the answers

What is the correct placement of the fingertips during the Head Tilt–Chin Lift Maneuver?

Under the patient's chin Signup and view all the answers

What is the purpose of the 'look, listen, and feel' technique?

To assess breathing Signup and view all the answers

Study Notes

Establishing an Artificial Airway

The ultimate goal of establishing an artificial airway is to ensure oxygen delivery to the cells, as all cells will die if deprived of oxygen.

Anatomical Perspectives

The airway is divided into the upper and lower airway.
The upper airway consists of the nose, mouth, oral cavity, pharynx, and larynx.
The lower airways include the trachea, bronchi, bronchioles, and alveoli within the lungs.
The glottis is the area between the vocal cords.

Artificial Airway

Definition: An artificial airway is a tube or tube-like device inserted through the nose, mouth, or into the trachea to provide an opening for ventilation.
Types of artificial airways: pharyngeal airways (oropharyngeal and nasopharyngeal) and tracheal airways (orotracheal, nasotracheal, tracheostomy tubes, and cricothyroid tubes).
Intubation: the process of placing an artificial airway into the trachea.
Routes: orotracheal intubation (tube passed through the mouth) and nasotracheal intubation (tube passed through the nose).

Indications for Artificial Airways

Relief of airway obstruction: guarantees the patency of the upper airway regardless of soft tissue obstruction.
Can be used in conjunction with a BVM device.
Correct sizing of the airway is imperative.

Oropharyngeal Airway

Advantages: simple to use, inexpensive.
Uses: to maintain an open airway, prevent endotracheal tube occlusion, prevent tongue bite, facilitate suction, and obtain a better mask fit.
Contraindications: intact gag reflex, oropharyngeal growth.
Hazards: injury due to incorrect size, laryngospasm in awake patients, and aspiration from intact gag reflex.

Oropharyngeal Airway Insertion

Techniques: jaw-lift technique and using a tongue depressor.

Nasopharyngeal Airway

Definition: a soft plastic or rubber tube designed to pass through one of the nares, inferior to the base of the tongue, and provide a clear path for gas flow into the pharynx.
Uses: to maintain an airway in patients with an intact gag reflex, facilitate suctioning, as a guide for a fiberscope or nasogastric tube, and to apply continuous positive airway pressure (CPAP).
Advantages: better tolerated than an oral airway in patients with intact gag reflex, useful in patients with jaw injury or spasm, and can be used when the mouth cannot be opened.
Contraindications: anticoagulation, infection, or tumor in the airway.

Airway Assessment

Look externally for conditions associated with difficult intubation, such as congenital anomalies, infection, tumor, or trauma.
LEMON assessment: a method to evaluate the ease of access to the airway, considering the size of the mandible, the distance between the mentum and the hyoid bone, and the extent of mouth opening.

Opening the Airway

Two methods: Head Tilt–Chin Lift Maneuver and Jaw-Thrust Maneuver.
Head Tilt–Chin Lift Maneuver: for patients who have not sustained trauma, used to open the airway.
Jaw-Thrust Maneuver: for patients with suspected cervical spine injury, used to open the airway.

Nasotracheal Intubation

Route of choice in certain clinical situations, such as when the oral route is unavailable.
Can be performed blindly or by direct visualization using a standard or fiberoptic laryngoscope with Magill forceps.
A smaller ETT may be needed, and the tube should be pre-lubricated with water-soluble gel to aid passage.

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Description

Quiz on establishing an artificial airway, including routes, equipment, and procedures for orotracheal and nasotracheal intubation in adults.