Airway Management Study Guide PDF

CHAPTER 10 – AIRWAY MANAGEMENT STUDY GUIDE The most basic components of emergency medical care are to establish and maintain an airway, ensure effective ventilation, and provide oxygen to the patient. Without an open and clear airway, adequate breathing, or sufficient oxygenation all other emergenc...

CHAPTER 10 – AIRWAY MANAGEMENT STUDY GUIDE The most basic components of emergency medical care are to establish and maintain an airway, ensure effective ventilation, and provide oxygen to the patient. Without an open and clear airway, adequate breathing, or sufficient oxygenation all other emergency care is futile since the patient will rapidly deteriorate and die. When you hear or think of the word AIRWAY, the first word that comes to mind should be MAINTAIN. How or with what device? When you hear or think of the word BREATHING, the first word that comes to mind is SUPPORT. How much, how many, and with what device or devices should you use to support breathing? 1. Ventilation a. The mechanical process of moving air in and out of the lungs b. AKA Breathing 2. Respiration a. The actual gas exchange process (O2 and CO2) b. Between alveoli and pulmonary capillaries c. Between cells and systemic capillaries 3. Anatomy a. Upper Airway i. From the nose and mouth to the larynx ii. Nose/nasopharynx iii. Mouth/oropharynx iv. Tongue (most common airway obstruction, listen for snoring) v. Epiglottis vi. Larynx / vocal cords b. Lower Airway i. Below larynx, from the trachea to the lungs 1. Trachea 2. Carina (where trachea branches off into the bronchi) 3. Bronchi (larger airways, lined with smooth muscle) 4. Bronchioles (smaller airways lined with smooth muscle, think asthma and emphysema. Susceptible to swelling, leads to wheezing) 5. Alveoli (permits gas exchange between bloodstream and lungs) c. Musculature i. Diaphragm ii. Intercostal muscles (between ribs) iii. Muscles help with the ability to breathe 4. Mechanics of Ventilation a. Inhalation i. Chest wall expands, diaphragm lowers  CHAPTER 10 – AIRWAY MANAGEMENT STUDY GUIDE ii. Creates negative pressure iii. Active process iv. Pulls air in, also aids in cardiac output b. Exhalation i. Chest wall relaxes, diaphragm to normal position ii. Pressure equalizes iii. Passive process 5. Control of Respiration a. Breathing stimulus (what stimulates you to breathe) b. Medulla oblongata (in brain stem) monitors chemoreceptors and stimulates a person to breath (among other things) i. Healthy people (without respiratory disease) 1. Hypercarbic drive 2. Increased CO2 levels ii. People with lung disease (damaged lungs, COPD [emphysema, chronic bronchitis]. Does not include asthma) 1. Hypoxic drive 2. Low levels of O2 c. Chemoreceptors i. Monitor oxygen, carbon dioxide, and pH in the blood ii. Located in the carotid arteries and aortic arch iii. Send messages back to medulla oblongata 6. Hypoxia (Important part of this entire course) a. Inadequate amount of O2 reaching cells i. Mild hypoxia / Early signs of hypoxia 1. Fast breathing, dyspnea, anxiety, apprehension, restless, pale skins ii. Severe hypoxia / Late signs of hypoxia 1. Altered level of consciousness (confusion, disorientation), cyanosis, dyspnea 7. Managing the Airway (Must remain PATENT at all times!) a. Air can be felt and heard moving in and out of the mouth and nose b. The patient is speaking in full sentences with ease or with little difficulty c. The sound of the voice is normal for the patient 8. Signs of an Inadequate Airway a. Abnormal upper airway sounds (see #9) b. A conscious patient who is unable to speak c. Foreign body airway obstruction d. ANY swelling of the mouth, tongue, or oropharynx 9. Abnormal Airway Sounds (One of the things we are looking for when we assess the airway in our ABC’s, especially on an unconscious patient)  CHAPTER 10 – AIRWAY MANAGEMENT STUDY GUIDE a. Snoring i. Upper airway partially obstructed ii. The tongue is most common iii. Can be relieved using heat tilt / chin lift b. Gurgling i. Liquid blocking airway 1. Usually blood, vomit, or secretions ii. Immediate suction needed! c. Stridor i. High pitched sound on inspiration 10. Opening the airway a. Head tilt – chin lift (for MEDICAL patients) b. Jaw thrust (for TRAUMA patients / suspected spinal injury) c. After opening airway, if first ventilation is unsuccessful, always reposition the airway (redo airway opening procedures), and try again. 11. Suctioning a. Two types i. Mounted (on board) ii. Portable 1. Powered 2. Manual (V-Vac) b. Suction Catheters i. Rigid 1. Yankauer, Tonsil Tip 2. For adults, oral only ii. Soft 1. French 2. For children, nasal, stoma, airway tubes c. Suction facts i. Always suction on the way OUT ii. 15 sec max adult iii. 5 sec max child iv. Always measure prior to insertion 1. Same measurements as airway adjuncts 2. If suctioning orally, use measurements for OPA 3. If suctioning nasally, use measurements for NPA d. Suction precautions i. Do not insert suction catheter too deep 1. Can damage soft tissue 2. Stimulate vagus nerve (may drop heart rate)  CHAPTER 10 – AIRWAY MANAGEMENT STUDY GUIDE ii. Do not suction too long 1. May cause hypoxia 2. May cause bradycardia iii. Always apply O2 (either NRB or positive pressure ventilation) for 2 minutes after suctioning 12. Airway Adjuncts a. Used to maintain airway patency in unresponsive patients b. Keeps tongue off back of the airway (throat) c. Oropharyngeal Airway (OPA) i. For patients who are: 1. Unresponsive / unconscious 2. No gag reflex ii. Sizing (can use either of these) 1. Corner of mouth to tragus or earlobe (easiest) 2. Middle of mouth to angle of jaw iii. Three methods of insertion 1. 180 degree method 2. 90 degree method 3. Tongue depressor method d. Nasopharyngeal Airway (NPA) i. Used when 1. Patient cannot maintain airway (unconscious, severely obtunded), and 2. Patient has a gag reflex (OPA cannot be used since patient has a gag reflex) ii. Sized two ways 1. Tip of nose to tragus or earlobe, and 2. Diameter of NPA slightly smaller than nare iii. Insert bevel towards septum 1. Use gentle force 2. If resistance is felt, then remove and try in other nostril 13. Managing Breathing a. Respiratory Rate and Tidal Volume i. Need both to determine if breathing is adequate or inadequate ii. Respiratory rate 15sec x4 iii. Tidal volume 1. Look for adequate chest rise b. Adequate Breathing i. Rate 1. Adequate range 8-24, normal 12-20  CHAPTER 10 – AIRWAY MANAGEMENT STUDY GUIDE ii. Rhythm 1. Regular pattern, each breath about same tidal volume iii. Quality 1. Full, equal breath sounds. Adequate tidal volume c. Inadequate Breathing i. Rate 1. Outside adequate range ii. Rhythm 1. Irregular patterns iii. Quality 1. Decreased breath sounds, decreased tidal volume iv. Examples – Apnea, agonal breathing, Cheyne-Stokes pattern, ataxia d. Common question: Should I assist ventilations with BVM or can I use a non- rebreather? i. If patient is breathing adequately, then a non-rebreather will suffice ii. If patient is breathing inadequately, then the patient needs assisted ventilations, so a BVM is necessary 14. Assisting Ventilations (Positive Pressure Ventilation) a. Two types i. Bag Valve Mask 1. Aka BVM ii. Flow-Restricted, Oxygen-Powered Ventilation Device 1. Aka FROPVD, or Demand Valve b. Basics of Assisting Ventilations i. Always ventilate using an adequate rate ii. Always make sure you have adequate seal iii. DO NOT OVER VENTILATE c. Normal spontaneous ventilation (normal breathing) vs Positive pressure ventilation i. Normal ventilation (breathing) creates negative pressure in the thoracic cavity, pulling air into the lungs and assisting the vena cava in pulling blood into the right atria ii. Positive pressure ventilation – mechanically pushing air into the lungs. 1. Can affect cardiac output, as the positive pressure does not assist the vena cava with pulling blood into the right atria d. Bag Valve Mask (BVM) i. Most common PPV (positive pressure ventilation) device ii. Capacity of ~1600cc iii. Delivers 100% oxygen, use at 15 liters per minute (LPM) of O2 iv. Look for adequate rise and fall of the chest when ventilating  CHAPTER 10 – AIRWAY MANAGEMENT STUDY GUIDE e. Flow Restricted, Oxygen Powered, Ventilation Device i. Can be used on spontaneously breathing patients ii. Delivers 100% O2, 40 liters per minute (LPM) when pressing trigger iii. Do not over ventilate! iv. Flow meter set at 0 liters per minute (LPM) 15. Stoma / Tracheostomy a. A hole cut into the trachea i. To relieve a foreign body airway obstruction (FBAO) ii. To insert an endotracheal tube iii. To perform a laryngectomy (most common) b. If a patient with a stoma needs assisted ventilations, the normal tracheostomy that a patient has is the same size as the port opening of a BVM (where you would put the BVM mask normally) 16. Oxygen Delivery (These next devices are for the patient with adequate breathing. For patients with inadequate breathing, use BVM or FROPVD) a. When to use oxygen i. Any patient with an oxygen saturation less than 94% or if hypoxia is suspected ii. A patient that complains of dyspnea or respiratory distress iii. Signs of poor perfusion (pale, cool, sweaty skins signs, altered level of consciousness, hypotension [low blood pressure], delayed capillary refill) iv. Heart failure v. Shock b. Non-Rebreather Mask (NRB) i. “High Flow O2” ii. Delivers ~90% oxygen iii. Use at 10-15 liters per minute (lpm) iv. Be sure to completely fill oxygen reservoir prior to placing on patient’s face c. Nasal Cannula (Nasal prongs) i. “Low Flow O2” ii. Delivers 24-44% oxygen iii. Use at 1-6 LPM iv.