Artificial Airways - Lesson 3 Procedures - Midland College PDF

Lesson 3 ¡ Specialized medical devices that are designed to maintain a patent (open) airway ¡ To relieve airway obstruction We can NOT prevent aspiration ¡ To facilitate the removal of secretions but we can try to protect from this...

Lesson 3 ¡ Specialized medical devices that are designed to maintain a patent (open) airway ¡ To relieve airway obstruction We can NOT prevent aspiration ¡ To facilitate the removal of secretions but we can try to protect from this happening ¡ To protect the lower airway from aspiration ¡ To facilitate application of positive pressure ventilation ¡ Endotracheal tubes may be used as an alternate route for drug administration ¡ Oropharyngeal Airways - also called " OPA or oral airway " ¡ Nasopharyngeal Airways - also called " NPA or nasal trumpets / nasal airway " ¡ Laryngeal Mask Airway - also called an " LMA " ¡ Esophageal Tracheal Combitube - also called " combitube or ETC " ¡ King Airway ¡ Endotracheal Tubes - also called " ETT or ET tube " ¡ Tracheostomy Tubes - also called " Trache tube " ¡ Laryngectomy Tubes - also called " Larry Tubes " ¡ Double Lumen Endotracheal Tubes - also called " DLT or DLETT " Advantage and Disadvantages Table 37.7  This is NOT in the Trachea!!!!! It is in the oral cavity and pharynx. ¡ Indications § Relieve upper airway obstruction by keeping the tongue off the posterior wall of oropharynx § Prevent tongue lacerations in seizure patient § Used as bite block with oral ET tube ¡ Poorly tolerated in alert patient due to stimulation of gag reflex (use in unconscious spontaneously breathing pt) ¡ Size selection § Come in different lengths § Rule of thumb: Measure from the corner of the mouth to the angle of the jaw - You will want to grab several because you will want to measure and make sure that you have the correct size for that patient ¡ Proper insertion § Place airway so that tip points toward the roof of the mouth (hard palate) ▪ Observe the airway pass the uvula and then rotate 180 degrees ¡ Proper insertion § Displace tongue with tongue depressor then slip curved part of the airway over the tongue ¡ Gagging or fighting the airway – remove the airway immediately ¡ Base of the tongue pushed into the back of the natural airway causing obstruction if airway is too large ¡ Aspiration of the airway or ineffective obstruction relief due to an airway that is too small ¡ 2 types of oropharyngeal airways § Berman § Guedel ¡ As shown in Fig 38.17, when properly inserted, the tip of an oropharyngeal airway lies at the base of the tongue above the epiglottis, with the flange portion extending outside the teeth. Only in this position can the device properly maintain airway patency ¡ Berman made of hard plastic and have a groove down either side to guide a suction catheter ¡ Guedel made of soft material and have an opening through the middle to allow passing of suction catheter When are oropharyngeal airways contraindicated? I. when foreign body obstruction already exists II. In patients who are unconscious or comatose III. In cases of oromaxillary or mandibular trauma A. I, II, III B. I, II C. I, III D. I Which of the following best describes the position of a correctly sized and properly inserted oropharyngeal airway? A. Distal tip at the base of tongue, flange inside anterior teeth B. Distal tip at level of uvula, flange extending outside the teeth C. distal tip at the base of tongue, flange outside the teeth D. Distal below the epiglottis, flange extending outside the teeth ¡ Indications § Maintains patency by lying between base of tongue and posterior wall of pharynx § Used when an oral airway cannot be placed § Used for frequent suctioning to minimize trauma ¡ Size selection § Sized by various external diameters and lengths § To size the airway, insert the largest diameter that can easily be passed with minimal force or trauma § Measuring the distance from tip of nose to tragus of ear approximates the length of airway ¡ Proper insertion § Lubricate the airway with a water- soluable gel and insert into patient’s nostril § Care should be taken to insert parallel to the floor of the nasal pharynx and slightly medial. Do not attempt to insert ”up the nose” § The flanged end should rest agaist the nose and the distal tip should rest behind the uvula ¡ Nasal bleeding ¡ Aspiration if airway is too small ¡ Nasal irritation (alternate nostril daily) ¡ Infection (change every 24 hours) A patient in the emergency department exhibits signs of acute upper airway obstruction and is concurrently having sever seizures that make it impossible to open the mouth. In this case, what would be the adjunct airway of choice? A. Oropharyngeal airway B. Oral endotracheal tube C. Nasopharyngeal airway D. Tracheostomy tube. How would you estimate the appropriate length for a nasopharyngeal airway? A. Subtract twice the diameter of the tube from its length B. Measure the distance from the earlobe to the Adam’s apple C. Apply the estimating formula: length (cm) = 15 + (age/2) D. Measure the distance from the earlobe to the tip of the nose ¡ “Mask on a tube” ¡ Used most often in OR setting ¡ Is not meant to replace ET tube but is a useful emergency device ¡ Insertion easy to teach and learn ¡ Advantages ¡ Disadvantages § Provides a patent airway that is § Not meant to be used for extended usually superior to that from an oral mechanical ventilation or nasopharyngeal device § Aspiration is not prevented § Does not require airway § Cannot provide high ventilation manipulation or extreme head pressures (typically