Unit 1 Exam - BVM and Airway Adjuncts (OPA, NPA, and LMA)

What are the 6 main causes of upper airway obstruction?

1. Tongue

2. Edema

3. Bleeding

4. Secretions

5. Foreign substances

6. Laryngospasm

What is the MAIN cause of upper airway obstruction?

The tongue falling back against the posterior wall of the pharynx.

What are 3 examples of foreign substances in relation to upper airway obstruction?

1. Foreign bodies

2. False teeth

3. Vomitus (vomit)

What are the 6 signs of PARTIAL airway obstruction?

1. Crowing, gasping sounds on inspiration (stridor)

2. Inability to cough (with slight obstruction the patient may be able to cough.

3. Increasing respiratory difficulty.

4. Good to poor air exchange (depending on the severity of obstruction)

5. Exaggerated chest and abdominal movement WITHOUT comparable air movement

6. Cyanosis (depending on severity of obstruction)

What are the 7 signs of COMPLETE upper airway obstruction?

1. Inability to talk

2. Increased respiratory difficulty with NO air movement

3. Cyanosis

4. Sternal, intercoastal, and epigastric (upper abdomen) retractions

5. Use of accessory muscles of the neck and chest

6. Extreme panic

7. Unconsciousness and respiratory arrest if obstruction is not removed.

What are the 3 treatments of airway obstruction?

1. If the patient is CONSCIOUS and has a PARTIAL obstruction, they should be monitored closely and allowed to try and relieve the obstruction on their own.

2. If the patient is CONSCIOUS and has a COMPLETE airway obstruction that is most likely caused by food or a foreign object, abdominal thrusts must be performed until object dislodges.

3. If the patient is UNCONSCIOUS and has a PARTIAL OR COMPLETE obstruction that is most likely caused by the tongue, the head tilt and chin lift maneuver will help relieve the obstruction by moving the tongue forward.

Describe the characteristics of the OPA.

Maintains a patent airway by lying between the base of the tongue and the posterior wall of the pharynx, preventing the tongue from falling back and occluding the airway.

When should the OPA be used?

Must ONLY be used on the unconscious patient.

Why is an OPA ONLY used on an unconscious patient?

Because a conscious patient would gag on the airway, potentially leading to aspiration.W

Why should the OPA never be taped in place?

Because the airway must be easily removeable to prevent vomiting and aspiration if the patient become conscious.

What are the 5 proper steps of placing an OPA?

1. Measure the airway from the corner of the lip to the angle of the jaw to ensure proper length.

2. Remove foreign substance from the mouth

3. Hyperextend the neck

4. Using the cross-finger technique, open the patients mouth and insert the airway with the tip pointing toward the roof of the mouth

5. Observe the airway passing the uvula and rotate the airway 180 degrees.

What are 4 hazards of OPA’s?

1. The patient may gag or fight the airway; if this occurs remove the airway IMMEDIATELY.

2. If the airway is inserted improperly, the base of the tongue may be pushed into the back of the throat, obstructing the airway.

3. If the airway is too large, the epiglottis may be pushed into the laryngeal area.

4. If the airway is too small, it may be aspirated or may be ineffective in relieving the obstruction.

Why must OPA’s be used in orally intubated patients?

To prevent the patient from biting the ET tube.

What are Berman airways made of? Where is a suction catheter guided?

They are made of hard plastic. They have a groove on either side to guide the catheter to the glottic area.

What are Guedel airways made of? Where is a suction catheter guided?

They are made of a soft and pliable material. They have an opening through the middle to allow the catheter into the glottic area.

Describe the characteristics of the NPA

Maintains a patent airway by lying between the base of the tongue and the posterior wall of the pharynx. It is constructed of soft, pliable rubber.

What are the 4 proper steps of inserting NPA’s?

1. Select the proper size by measuring the airway from the tip of the nose to the earlobe. The outside diameter of the airway should be equal to the inside diameter of the patients’ internal nares.

2. Lubricate the airway with water-soluble gel and insert into the patients nostril.

3. The flanged end should rest against the nose, and the distal tip should rest behind the uvula.

4. Place tape around the flanged end to secure the airway in place.

The NPA airway is tolerated by what patients?

By conscious patients. It allows them to eat, drink, and speak.

What is the NPA most commonly used to facilitate?

Nasotracheal suctioning

What are the two hazards of NPA’s?

1. An airway that is too small may be aspirated.

2. Nasal irritation may result, to prevent this alternate nostrils daily.

Describe the characteristics of LMA

Designed to be used as an alternative to a face mask for achieving and maintaining control of the airway during surgery when tracheal intubation is not necessary, or in emergencies when ET intubation cannot be accomplished after several tries.

Consists of a tube that is fused to an elliptical spoon shaped mask. The mask has an inflatable rim that is filled with air via a pilot valve balloon system.

For an LMA to be inserted correctly what should the patient be under?

The patient must be anesthetized so the upper airway reflexes are obtunded, otherwise laryngospasm can occur.

How is the LMA inserted?

It is inserted through the mouth and into the pharynx after being lubricated with water-soluble gel. It is advanced until resistance is met, then the mask is inflated providing a low-pressure seal around the laryngeal inlet.

The posterior aspect of the tube is marked with a black line that should be seen midline against the patient’s upper lip if the airway is properly placed.

What are the 4 indications for LMA?

1. Difficult face mask fit

2. Unsuccessful intubation and difficulty ventilating with bag mask.

3. Unavailability of personnel trained in ET intubation

4. Elective surgical procedures.

What are the 2 contraindications for LMA?

1. Health care provider not trained in the use of the LMA

2. If risk of aspiration exists

What are 8 advantages of the LMA?

1. Can be quickly inserted to provide ventilation when bag-mask ventilation is not adequate and ET intubation cannot be accomplished.

2. VT delivered may be greater when the LMA is used as opposed to bag-mask ventilation.

3. There is less gastric insufflation than with bag-mask ventilation

4. The LMA ventilates equally as well as an ET tube.

5. Training is simpler than for ET intubation

6. There is no risk of esophageal or bronchial intubation.

7. There is less risk of trauma to the airway than with ET intubatino

8. There is less coughing, laryngospasm, sore throat, and hoarseness than with ET intubation.

What are 4 disadvantages of LMA?

1. Does not provide protection against aspiration of gastric contents

2. cannot be used if the mouth cannot be opened more than 0.6 inches (1.5 cm)

3. May not be effective when airway anatomy is abnormal

4. May be difficult to provide adequate ventilation if high airway pressures are required.

Describe the insertion technique of the LMA

Using the index finger you advance the LMA until resistance is met. The tip of the LMA should rest against the upper esophageal sphincter in the hypopharynx. The cuff should be inflated until no leak is heard. To determine proper position auscultate the lungs bilaterally. Capnography also can be used to confirm that the airway is properly positioned.

How do you determine mild laryngospasm as a result of light anesthesia when using LMA?

Auscultate the anterolateral neck for the presence of wheezing.

What should the patient NOT do before LMA insertion?

They should not eat for several hours before because the LMA does not protect the airway from regurgitation.

What are the 3 uses of manual resuscitators?

1. Manual ventilation

2. Hyperinflation of lungs before tracheal suctioning.

3. During transport of patient who requires artificial ventilation.

What is the function of the exhalation valve and ports?

Prevent the rebreathing of exhaled air

If a reservoir is not attached to the bag how much FiO2 is delivered?

40-50%

What 3 criteria ensure the highest delivered O2 levels possible?

1. Always use a reservoir attachment

2. Use the highest flow rate (10-15 L/min)

3. Use the longest possible bag refill time (meaning a slower ventilation rate)

During respiratory arrest whats the recommended breath-second?

one breath every 5-6 seconds

What are 3 hazards of using manual resuscitators?

1. Leaks during inspiration caused by improperly fitted face mask or inadequately filled ET tube cuff.

2. Equipment malfunction caused by sticking valves, missing parts, improper assembly. or dirty valve mechanisms.

3. Poor ventilation technique.