Airway Management & Resuscitation Devices PDF

Airway Management and Emergency Resuscitation Devices Upper Airway Obstruction  Causes:  Soft tissue obstruction  Laryngeal obstruction  Central nervous system depression  Drug OD  Anesthesia  Cardiac arrest  Loss of consciousness ...

Airway Management and Emergency Resuscitation Devices Upper Airway Obstruction  Causes:  Soft tissue obstruction  Laryngeal obstruction  Central nervous system depression  Drug OD  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 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 Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 3 Head Tilt  Performed by tilting head backward, slightly hyperextending the neck  “Sniffing position”  One hand on forehead & head is tilted backward  Do not use w/ suspected cervical spine injury! Anterior Mandibular Displacement  Opens AW sans spinal cord manipulation  Mandible is advanced anteriorly by grabbing both sides of ramus  Tongue is displaced anteriorly, opening the AW Artificial Airways  Designed to maintain a patent AW  Oropharyngeal Airway  Nasopharyngeal Airway  Laryngeal Mask Airway  Mouth-to-Mask Ventilation Devices Oropharyngeal airways  Rigid curved device with air passage that is placed through mouth with end resting distal to tongue  Designed to relieve obstructions in the unconscious pt caused by tongue or other soft tissue  Never used with patients who are conscious.  Contraindications: gagging or vomiting, improper size, incorrect placement  When properly placed, it separates the tongue from the posterior wall of the pharynx Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 7 Oropharyngeal Airways Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 8 Insertion Technique for Oropharyngeal Airway  Insert tip toward roof of mouth  When it’s halfway in, rotate airway device 180 degrees and slide into pharynx  Oropharyngeal can only be used with unconscious patients Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 9 Insertion Technique for Oropharyngeal Airway Nasopharyngeal airways  Soft or semi rigid hollow tube placed through nares, with tip distal to tongue and above 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 Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 11 Nasopharyngeal Airways (Cont.)  Primary indication is to facilitate nasotracheal suctioning  Too small = continued obstruction  Too big = epiglottis held shut  Contraindications: gagging or vomiting (usually better tolerated in conscious or semiconscious patients); posterior pharyngeal wall dissection; severe bleeding  Nasal bleeding is most common complication  Airway must be lubricated during insertion  May use local anesthetic mixed with vasoconstrictor (0.4% lidocaine and phenylephrine)  Airway is inserted gently through nares  Never secured Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 12 Nasopharyngeal Airways Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 13 Laryngeal mask airway  Designed so the tip rests against upper esophageal sphincter & sides face the pyriform fossae, lying just under base of tongue  Seals off the esophagus  Black line should always face the upper lip!  Confirm placement w/ BS, ETCO2, and CXR Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 14 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 of laryngeal airway Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 15 Laryngeal Mask Airway Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 16 Determining the Appropriate Size for a Laryngeal Mask Airway Mask Size Age Group Patient Weight 1 Neonates/infants Up to 5 kg. 1.5 Infants 5-10 kg. 2 Infants/children 10-20 kg 2.5 Children 20-30 kg 3 Children 30-50 kg 4 Adults 50-70 kg Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 17 Determining the Appropriate Size for a Laryngeal Mask Airway (Cont.) Mask Size Age Group Patient Weight 5 Adults 70-100 kg 6 Large adults >100 kg Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 18 Intubating a Laryngeal Mask Airway Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 19 Combitube  Double-lumen tube is inserted blindly as alternative to endotracheal intubation  Has two cuffs: large cuff in pharynx and small cuff at the distal end of device  Cuff inflation volumes:  Distal cuff: 12 to 15 mL  Pharyngeal cuff: 85 to 100 mL  Contraindications: not considered secure airway device; should not be used in patients with intact gag reflexes or esophageal disease; may cause injury to esophagus, trachea, or surrounding soft tissue  For use in adults only  Not recommended for persons under 60 inches in height Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 20 Combitube Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 21 Insertion of a Combitube Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 22 Mouth-to-Mask Ventilation Devices  Soft-seal mask + one-way valve (and/or filter) to separate pt & practitioner  May have valve for supplemental O2  If not, wear a NC!  Supplemental O2 can FiO2 to 70%  Secure mask w/ both hands  A tight seal is very important! Mouth-to-Mask Ventilation Devices Transtracheal invasive airway  Direct entry into trachea below larynx with large-bore needle or surgical insertion of endotracheal tube  Contraindications: hypoxemia, bleeding, nerve or esophageal injury; failure to establish an airway; pneumothorax Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 25 Tracheostomy tube  Hollow tube with or without cuff that is electively inserted into trachea through surgical incision or wire guided progressive dilation technique  Contraindications: hypoxemia, bleeding, nerve or esophageal injury; failure to establish airway due to nasotracheal placement Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 26 Endotracheal Intubation  Most reliable method of ensuring an airway  Purposes of intubation:  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 Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 27 Manual Resuscitators  Provide ability to deliver positive pressure breath  Used to provide ventilation when CPR is being performed  Used to provide ventilation when patient is removed from ventilator Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 28 Manual Resuscitators (Cont.) Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 29 Types of Manual Resuscitators  Spring loaded  Uses disk or ball attached to spring  When bag is compressed, ball or disk is pushed to its open position and air enters patient’s lung  When bag is released, ball or disk returns to resting position  Patient is able to exhale into atmosphere Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 30 Types of Manual Resuscitators (Cont.)  Duckbill valves  Uses diaphragm instead of spring-loaded valve  When bag is compressed, valve is opened and volume is delivered to lungs  When bag is released, valve closes and patient is able to exhale into atmosphere Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 31 Duckbill Resuscitator Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 32 Types of Manual Resuscitators  Leaf valve  Similar to duckbill resuscitator; instead of duckbill, a leaf opens when breath is delivered Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 33 Standards for Manual Resuscitators  American Society for Testing and Materials and International Organization for Standardization recommends that manual resuscitators be capable of delivering a FIO2 of 0.85 with oxygen flow of 15 L/min  Manual resuscitators should be able to operate at extreme temperatures and a relative humidity of 40% to 96%  Adult resuscitators should deliver tidal volume of at least 600 mL into test lung set at compliance of 0.02 L/cm H 2O and airway resistance of 20 cm H2O/L/sec  The resuscitator’s nonrebreathing valve must not jam at oxygen flows up to 30 L/min Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 34  Standards for Manual Resuscitators (Cont.)  If valve malfunctions due to obstruction, valve must be restored to proper function in 20 seconds  Patient connections must have 15:22-mm adapter  Rusticators intended for adults should not have a pressure release valve  Resuscitators intended for infants or children should have a pressure release valve set for 40 cm H2O +/− 10 cm H2O  When manual resuscitator has a pressure release valve, there needs to be a mechanism to override it  Resuscitator needs to remain functional after being dropped 1 meter onto concrete floor Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 35 Hazards of Manual Resuscitators  Delivery of excessive airway pressure  Malfunction of nonrebreathing valve  Improper fit of mask, resulting in low tidal volumes Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 36