Airway Management PDF

Airway Management  Objectives Airway / Breathing – Assessment – Adjuncts – Treatment Oxygen Therapy – Tanks – Non-Rebreather – Nasal Cannula  Mechanics of Breathing Controlled by the Medulla Oblongata Major muscle of inspiration is the Diaphragm Ne...

Airway Management  Objectives Airway / Breathing – Assessment – Adjuncts – Treatment Oxygen Therapy – Tanks – Non-Rebreather – Nasal Cannula  Mechanics of Breathing Controlled by the Medulla Oblongata Major muscle of inspiration is the Diaphragm Negative pressure Stimulus is increased CO2 Normal tidal volume is 500cc MANAGING THE AIRWAY  Assessing the Airway Must remain secured AT ALL TIMES – Air moving in and out – Speaks with ease and in full sentences – No abnormal sounds – Understand: Respiration is the exchange of O2 and CO2, while ventilation is the movement of air that carries them into and out of the body. ABNORMAL AIRWAY SOUNDS  Snoring Upper airway partially obstructed Most always the tongue  Stridor High pitched sound on inspiration Usually caused by a swollen larynx.  Gurgling (CRACKLING) Suction is the priority  Opening the Airway Head Tilt-Chin Lift Modified Jaw-Thrust Opening the Airway in Children Same as before, but… – Place a towel under shoulders  Suctioning Two types – Mounted (on board) – Portable Battery Powered Manual  Suction Catheters Rigid – Yankauer (Tonsil Tip) – For adults, oral only Soft – French (Soft) – For children, nasal, stoma, airway tubes  Things to know Always suction on the way OUT 15 sec max adult 5 sec max child Always measure prior to insertion  Precautions Do not insert too deep – Can damage soft tissue – Stimulate Vagus Nerve Do not suction too long – May cause hypoxia – May cause bradycardia Always apply O2 after suctioning AIRWAY ADJUNCTS  Airway Adjuncts Used to maintain airway patency Keeps tongue off back of throat  Oropharyngeal Airway For patients who are: – Unresponsive – No gag reflex  OPA o Sizing o Corner of mouth to tragus of ear o Middle of mouth to angle of jaw o Methods of insertion o 180 degree method o 90 degree method  Nasoparyngeal Airway Used when: – Patient cannot maintain airway – Has a gag reflex (no OPA)  NPA Sized two ways – Tip of nose to tragus of ear – Diameter slightly smaller than nostril Insert bevel towards septum – Use gentle twisting force – Resistance? Try other nostril MANAGING BREATHING  Respiratory Rate (RR) Tidal Volume(TV) Need both to determine if breathing is adequate or inadequate Respiratory rate 15sec x4, or 30sec x2 Tidal volume – Look for adequate chest rise  Adequate Breathing Rate – 8-24, normal 12-20 Rhythm – Regular pattern, each breath about same tidal volume Quality – Full, equal breath sounds. Adequate tidal volume  Inadequate Breathing (Agonal Respirations) Rate – Outside normal limits Rhythm – Irregular patterns Quality – Decreased breath sounds, decreased tidal volume Signs of Inadequate Breathing Hypoxia (Lack of O2 to the cells) Early sign is restlessness Late sign is cyanosis  Should I Assist Ventilations? If either or both RR and TV are inadequate. Patient is Apneic THEN YES!  Two Types of Positive Ventilation Devices Bag Valve Mask – Aka BVM Flow-Restricted, Oxygen-Powered Ventilation Device – Aka FROPVD, or Demand Valve  Assisting Ventilation Basics Always use adequate rate Always make sure you have adequate seal DO NOT OVER VENTILATE  Normal Respiration –vs- Positive Pressure Ventilation Normal Respiration – Negative pressure PPV – Positive pressure – Can affect cardiac output and hypotension – Gastric distension – Difficult getting a tight seal  Bag Valve Mask Aka BVM Most common PPV device Capacity of ~1600cc Delivers 100% oxygen  FROPVD (Flow Restricted, Oxygen-Powered Ventilation Device) Can be used on spontaneously breathing patients Delivers 100% O2, 40 liters per minute (LPM) Use with caution – Only adult patients – Do not over ventilate! – Make sure the flow meter is set to 0 Oxygen Delivery Oxygen Tank Non-rebreather Mask Nasal Cannula  Non-rebreather Mask High Flow O2 Delivers ~90% oxygen Use at 10-15 LPM Be sure to fill bag  Nasal Cannula Low Flow O2 Delivers 24-44% oxygen Use at 1-6 LPM THE END