Upper Airway Obstruction Causes and Maneuvers

Upper Airway Obstruction - Causes

• Soft tissue obstruction
• Laryngeal obstruction
• Central nervous system depression
• Drug overdose
• Anesthesia
• Cardiac arrest
• Loss of consciousness
• Space-occupying lesion
• Edema
• Foreign body aspiration

Supraglottic Airway Maneuver

• Extreme extension (sniffing position): Extension of head with occipital region on a towel.
• Contraindications: Unstable cervical spine.
• Jaw thrust or chin lift: Anterior displacement of mandible with or without dislocation of temporomandibular joints.
• Contraindications: Temporomandibular joint disease, fractured mandible, or unstable cervical spine.
• Jaw thrust: Used with suspected injury to cervical spine.

Head Tilt

• Performed by tilting head backward, slightly hyperextending the neck.
• "Sniffing position": One hand on forehead and head tilted backward.
• Do not use with suspected cervical spine injury.

Anterior Mandibular Displacement

• Opens airway (AW) without spinal cord manipulation.
• Mandible is advanced anteriorly by grabbing both sides of the ramus.
• Tongue is displaced anteriorly, opening the airway.

Artificial Airways

• Designed to maintain a patent airway.
• Oropharyngeal airway
• Nasopharyngeal airway
• Laryngeal mask airway
• Mouth-to-mask ventilation devices

Oropharyngeal Airways

• Rigid, curved device placed through the mouth, resting distal to the tongue.
• Relieves obstructions in unconscious patients (tongue or other soft tissue).
• Never used with conscious patients.
• Contraindications: Gagging, vomiting, improper size, incorrect placement.
• Separates the tongue from the posterior wall of the pharynx when properly placed.

Insertion Technique for Oropharyngeal Airway

• Insert tip toward roof of mouth.
• When halfway in, rotate the airway device 180 degrees and slide into the pharynx.
• Only use with unconscious patients.

Nasopharyngeal Airways

• Soft or semi-rigid, hollow tube placed through nares (nostrils).
• Tip is distal to the tongue and above the glottic opening.
• Separates tongue from soft palate.
• Tragus of ear to tip of nose.
• Also referred to as nasal trumpets or nasal airways.
• Can be used in conscious and semiconscious patients.
• Size is labeled in diameter or circumference.

Nasopharyngeal Airways (Continued)

• Primary indication: Facilitating nasotracheal suctioning.
• Contraindications: Gagging, vomiting, posterior pharyngeal wall dissection, severe bleeding (usually better tolerated in conscious/semiconscious patients.)
• Nasal bleeding is a common complication.
• Airway must be lubricated during insertion.
• May use local anesthetic mixed with vasoconstrictor (0.4% lidocaine and phenylephrine).
• Inserted gently through nares.
• Never secured.

Laryngeal Mask Airway

• Designed so the tip rests against the upper esophageal sphincter, sides facing the pyriform fossae, lying just under the base of the tongue.
• Seals off the esophagus.
• Black line should always face the upper lip.
• Confirm placement with:
  • Blood pressure (BP)(BS)
  • End-tidal carbon dioxide (ETCO2)
  • Chest X-ray (CXR)

Contraindications for Use of Laryngeal Mask Airway

• Full stomach or inability to confirm fasting status.
• Retained gastric contents.
• Severe gastroesophageal reflux.
• Decreased compliance or high airway resistance requiring high-ventilating pressure.
• Patient is conscious and/or resisting placement.

Determining the Appropriate Size for a Laryngeal Mask Airway

• A table correlates mask size with age group and patient weight.

Intubating a Laryngeal Mask Airway

• Procedure details, including diagrams, for intubation
• Diagrams include landmarks of the larynx

Combitube

• Double-lumen tube used as an alternative to endotracheal intubation.
• Has two cuffs (one large in the pharynx, one small distally).
• Distal cuff: 12-15 mL
• Pharyngeal cuff: 85-100 mL
• Contraindications: Not considered a secure airway device; should not be used in patients with intact gag reflexes or esophageal disease; can cause injury to esophagus, trachea or surrounding soft tissue.
• For use in adults only.
• Not recommended for persons under 60 inches in height.

Insertion of a Combitube

• Detailed, step-by-step procedure.
• Includes diagrams corresponding to the steps.

Mouth-to-Mask Ventilation Devices

• Soft-seal mask + one-way valve (and/or filter) to separate the patient and practitioner.
• May have valve for supplemental O2.
• If not, use nasal cannula (NC).
• Supplemental O2 can adjust FiO2 to 70%.
• Secure mask with both hands; a tight seal is very important.

Transtracheal Invasive Airway

• Direct entry into the trachea below the larynx with a large-bore needle or surgical insertion of an endotracheal tube.
• Contraindications: Hypoxemia, bleeding, nerve or esophageal injury; failure to establish an airway; pneumothorax.

Tracheostomy Tube

• Hollow tube (with or without a cuff) inserted into the trachea surgically or with wire-guided progressive dilation.
• Contraindications: Hypoxemia, bleeding, nerve or esophageal injury; failure to establish an airway due to nasotracheal placement.

Endotracheal Intubation

• Most reliable method of ensuring an airway.
• Purposes:
  • Ventilation of lungs even when high pressure is necessary.
  • Direct access to lungs for secretion removal and drug delivery.
  • Prevention of aspiration.
  • Access to lungs for bronchoscopy.

Manual Resuscitators

• Provide ability to deliver positive pressure breaths
• Used to provide ventilation when CPR is being performed.
• Used to provide ventilation when patient is removed from a ventilator.

Types of Manual Resuscitators

• Spring-loaded: Uses a disk or ball attached to a spring; compressed to push to open position to deliver air to the lungs then spring returns to resting position
• Duckbill valves: Uses a diaphragm instead. When the bag is compressed, the valve opens and volume is delivered to the lungs; when the bag is released, the valve closes and the patient exhales into the atmosphere
• Leaf valves: Similar to duckbill; instead of a duckbill, a leaf opens when breath is delivered

Standards for Manual Resuscitators

• American Society for Testing and Materials (ASTM) and International Organization for Standardization (ISO) requirements.
• Manual resuscitators should deliver oxygen at specific flow rates, function within specific temperature ranges, and provide sufficient tidal volume.

Hazards of Manual Resuscitators

• Delivery of excessive airway pressure.
• Malfunction of non-rebreathing valve.
• Improper fit of mask, resulting in low tidal volumes.

This quiz covers the various causes of upper airway obstruction, including soft tissue and laryngeal obstructions, as well as conditions such as drug overdose and cardiac arrest. It also explores airway management techniques like the supraglottic airway maneuver and head tilt adjustments. Test your understanding of these critical medical concepts and practices.