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Questions and Answers
What is the primary reflex action the body uses to protect the airway?
Which of the following is NOT a component necessary for adequate oxygenation?
Which respiratory rate indicates bradypnea?
What initial compensatory response occurs under hypoxic conditions?
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In assessing lung sounds, where is the preferred site for auscultation?
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What is the normal range for respiratory rate in adults?
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What condition is indicated by a SpO2 reading of less than 95%?
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When comparing lung sounds, what should be noted for normal healthy lungs?
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What is the primary purpose of a BVM (Bag-Valve-Mask) device?
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What can inadequate or hyperextension of the head during bag-mask ventilation lead to?
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Which maneuver is NOT typically used to open the airway of an unconscious patient?
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What is an important assessment technique to evaluate effective ventilation?
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Which of the following is NOT a potential danger of poor BVM technique?
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What generally causes upper airway obstruction in unconscious patients?
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What is the role of the Oropharyngeal Airway (OPA) in airway management?
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Which of these factors is NOT typically considered when assessing ventilation effectiveness?
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What is a possible complication of nasopharyngeal suctioning?
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Which device is specifically designed to take the place of a Combi-tube?
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What should be avoided in a patient with an intact gag reflex when considering airway management?
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What complication may result from suctioning that could cause a decrease in heart rate and blood pressure?
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Which statement about esophageal suctioning is true?
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What should be considered when suctioning a patient with a head injury?
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Which size of King LT is indicated for patients over 6 feet tall?
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What is a primary indication for using a Laryngeal Mask Airway (LMA) device?
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Study Notes
Ventilation Devices
- Two-person BVM ventilation requires one person to hold the mask in place and maintain an open airway, while the other squeezes the bag with two hands.
- Pocket mask is a clear plastic device covering the patient's mouth and nose, often supplied with a one-way valve.
Assessment of Manual and Internal Ventilations
- Patency: Assess if the bag is easy to squeeze.
- Chest rise: Observe for equal and bilateral chest rise.
- Lung sounds: Check for improvement or equalization of lung sounds.
- Level of consciousness: Monitor for improvement in LOC.
- Respiratory rate: Assess intrinsic respiratory rate.
- Mucous membrane color: Observe for improvement in cyanosis.
- Pulse oximetry readings: Do not treat the machine, but note the readings.
- Gastric distention: May be caused by inadequate or hyperextension of the head, excessive pressure from the ventilatory device, or improperly placed airway adjuncts.
Dangers of Poor BVM
- Gastric insufflation: Air enters the stomach.
- Vomiting and aspiration: May occur due to gastric insufflation.
- Hypoxia: Inadequate oxygenation.
- Cerebral vasoconstriction: Narrowing of blood vessels in the brain.
- Acid-base imbalances: Disturbance in the body's pH balance.
- Pneumothorax: Collapsed lung.
BLS Airway
- Upper airway obstruction can be caused by factors such as the tongue, foreign bodies, vomit, trauma, blood, teeth, laryngeal spasm, edema, burns, and infection.
- Unconscious patients lose muscle control, allowing the tongue to fall back against the back of the throat.
Treatment for BLS Airway Obstruction
- Head-tilt/chin-lift maneuver
- Modified jaw thrust maneuver
- Jaw-lift maneuver
BLS Airway - OPA (Oropharyngeal Airway)
- The OPA is used to maintain an open airway in an unresponsive patient who has no gag reflex.
Anatomy/Physiology
- The body utilizes reflexes such as coughing to protect and maintain the airway.
Assessment
- Look: Chest rise, trismus, vomit/blood, skin color, retractions.
- Listen: Gurgling, snoring, absent sounds, lung sounds, stridor, potato voice.
- Feel: Chest rise, equal chest rise.
Auscultation
- Normal healthy lungs are clear and equal in apices and basis.
-
Anterior sites:
- L/R Mid clavicular line just under the clavicle
- L/R mid axillary line ~ 5 intercostal space (nipple line)
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Posterior sites:
- L/R paraspinal border above the scapula
- L/R mid axillary line ~ 8th intercostal space (half way down the back)
- The posterior site is preferred due to the greater surface area of the lungs.
- To assess the R middle lobe, auscultate the anterior thorax.
Normal Respiratory Rate
- Normal RR: 12-20 breaths per minute.
- Assist at < 10 or > 30 bpm.
- Tachypnea: Increased respiratory rate.
- Bradypnea: Decreased respiratory rate.
Oxygenation
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Adequate oxygenation depends on four things:
- Adequate concentration of inspired O2 (FiO2)
- Movement of O2 across the alveolar capillary membrane (external respiration)
- Adequate RBC and Hgb to transport oxygen
- Offloading of O2 at the cellular level (internal respiration)
- Hypoxia: Decreased or inadequate supply of oxygen.
- SPO2 < 95% indicates hypoxia.
- Tachycardia is the first compensatory response to nearly every physiological stressor and should never be overlooked.
Nasopharyngeal Suctioning
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Complications:
- Hypoxia
- Aspiration
- Laryngospasm
- Bronchospasm
- Nasal obstruction
- Esophageal suctioning
- Catheter coiling in the nasopharynx
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Equipment:
- Suction device (mechanical)
- Catheters (size 6.5-18 French)
- Sterile water (to clean the catheter after suctioning)
- Lubricant
- If your suction catheters do not have a thumb hole, you will also need a Y connector.
BLS Airway - Suction
-
Precautions:
- Suctioning can stimulate the gag reflex, inducing vomiting.
- Suctioning can cause vagal stimulation, depressing heart rate and blood pressure.
- Suctioning can stimulate coughing, which can increase ICP in patients with head injuries.
BLS Airway - FBAO (Foreign Body Airway Obstruction)
- Review current FBAO guidelines for conscious and unconscious patients with varying levels of airway obstruction.
Blind Insertion Airway Devices (BIADs)
- These are in the scope of practice for paramedics.
-
Examples:
- King LT
- Laryngeal Mask Airway (LMA)
- I-Gel
King-LT
- Designed to replace the Combi-tube.
-
Features:
- Two cuffs: distal (small) and proximal (large)
- Single line to fill both cuffs
- One ventilation tube
- No distal ventilation opening, only ports between cuffs
- Facilitates Bougie tube placement
- Available in multiple sizes:
- 3: 4-5 feet (yellow)
- 4: 5-6 feet (red)
- 5: > 6 feet (purple)
King-LT Indications
- Unconscious patient with no gag reflex who requires:
- Airway management during cardiac arrest
- Airway management with transport time > 20 minutes
- SPO2 < 90% refractory to effective BLS management
King-LT Contraindications
- Intact gag reflex
- Upper airway burns
- Ingestion of caustic substances
- Esophageal varices
LMA (Laryngeal Mask Airway)
- Contraindications and indications are identical to the King LT.
LMA Sizing
- King LT is for adults only.
- LMA is for pediatrics.
BIAD (Blind Insertion Airway Device) Placement
- I-Gel Sizing: Use a size chart for appropriate sizing.
- Minimal Occlusive Pressure: The King LT cuff is located next to the internal jugular vein.
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Description
Test your knowledge of ventilation devices, including the two-person BVM and pocket mask. This quiz also covers the assessments required for manual and internal ventilations, focusing on key indicators such as lung sounds, chest rise, and patency. Perfect for students and professionals in emergency care.
