Loss of Spontaneous Respiration and Airway

Causes of loss of spontaneous respiration and airway compromise.

-Soft tissue obstruction

-Laryngeal obstruction

-Central nervous system depression

-Drug OD

-Anesthesia

-Cardiac arrest

-Loss of consciousness

-Space-occupying lesion

-Edema

-Foreign body aspiration

Indications for pulmonary resuscitation

Loss of spontaneous ventilation via upper and lower airway obstruction or altered respiratory drive.

Contraindication for resuscitation

Clearly expressed and documented patient desire (DNR/DNI).

Failure to restore gas exchange

Results in hypoxic brain injury and death.

Requirements to get a patent airway for a patient

Functional AC membrane and positional maneuvers to open the airway.

Focus of positional airway maneuvers

Reposition the airway so the tongue moves anteriorly away from the posterior pharynx which opens up the upper airway

Methods to open the upper airway

Head tilt or anterior mandibular displacement.

Head Tilt/Chin Lift technique

Tilt head backward, slightly hyperextending the neck into the "sniffing position" using one hand on the forehead.

Contraindication for Head Tilt/Chin Lift

Suspected cervical spine injury.

Anterior Mandibular Displacement (Jaw Thrust)

Opens the airway without spinal cord manipulation.

Jaw Thrust Technique

Mandible is advanced anteriorly by grabbing both sides of the ramus, displacing the tongue anteriorly which opens the airway

C/E Technique

Combines head tilt and jaw thrust when bagging without c-spine injury (C creates the seal and E pulls up the mandible/ramus).

Artificial Airways

Designed to maintain a patent airway.

Supraglottic Airways

Located above the glottis; not true airways and are more so adjuncts.

The supraglottic airways are

-Oropharyngeal Airway

-Nasopharyngeal Airway

-Laryngeal Mask Airway

Subglottic Airways

True and established airways.

The subglottic airways are

-ETT Tube

-Tracheostomy Tube

A device and airway used for artificial ventilation.

-Combitube Airway

-Mouth-to-Mask Ventilation Devices

Oropharyngeal Airway (OPA) purpose

Relieves obstructions in the unconscious pt caused by tongue or other soft tissue.

Proper placement of OPA

Separates the tongue from the posterior wall of the pharynx.

Too small OPA result

Continued obstruction.

Too large OPA result

Epiglottis held shut.

Correct OPA size/placement

Posterior tip of AW @ base of tongue.

Alternative use for OPA

Can also be used as a bite block.

Nasopharyngeal Airway (NPA) function

Separates tongue from soft palate

Indications for Nasopharyngeal Airway

Relieve nasopharyngeal obstruction & frequent repeated nasotracheal suction

Nasopharyngeal Airway sizing

Use largest size possible (Tragus of ear to tip of nose)

Nasopharyngeal Airway placement

Tip should rest between tongue & soft palate

Too small Nasopharyngeal Airway result

Continued obstruction

Too big Nasopharyngeal Airway result

Epiglottis held shut

Nasopharyngeal Airway length and diameter relationship

The longer the NPA the larger the diameter vice versa

Laryngeal Mask Airway placement

Designed so the tip rests against upper esophageal sphincter & sides face the pyriform fossae, lying just under base of tongue

Laryngeal Mask Airway function

Seals off the esophagus

Laryngeal Mask Airway black line rule

If your LMA has a black line, it should always face the upper lip

Laryngeal Mask Airway placement confirmation

Breath sounds, End-Tidal CO2, and Chest x-ray

Laryngeal Mask Airway pilot balloon

Helps us tell if it's inflated

Types of Manual Resuscitators

Flow-Inflating, Permanent Self-Inflating, Disposable Self-Inflating, and Portable & Handheld.

Purpose of Manual Resuscitators

Provide a means of delivering positive-pressure ventilation to a patient's airway.

Most Common Indication for Manual Resuscitators

Ventilate bradypneic or apneic patients.

Hyperoxygenation via Manual Resuscitators

Hyperinflate patients with oxygen before and after suctioning procedures to hyperoxygenate them

Lung Expansion via Manual Resuscitators

Generate airway pressures and large tidal volumes to expand atelectatic lung segments.

PEEP Valve and Manual Resuscitators

Manual Resuscitators also allow for the addition of positive end-expiratory pressure (PEEP) valve.

Flow-Inflating Manual Resuscitator alternative name

Also known as an 'anesthesia bag'.

Gas requirement for Flow-Inflating Manual Resuscitators

They rely on gas flow to inflate.

Flow rates for Flow-Inflating Manual Resuscitators

Runs at 10 lpm for peds and 15 lpm for adults.

Oxygen delivery capabilities of Flow-Inflating Manual Resuscitators

May deliver 100% O2 or any FiO2 if set on a blender.

Resistance in Flow-Inflating Manual Resuscitators

Little 'built-in' resistance, allowing you to feel lung compliance.

Meaning of increased bagging resistance in Flow-Inflating Manual Resuscitators

Harder to bag equals worsening lung compliance.

Operating requirements for Flow-Inflating Manual Resuscitators

Has to have a gas source and a seal.

CPAP with Flow-Inflating Manual Resuscitators

You can do CPAP using this device due to the continuous flow.

Permanent Self-Inflating Manual Resuscitators

Designed to be cleaned & reused. (Hopefully, you will never ever see one)

Disposable Self-Inflating Manual Resuscitator

May be used to deliver 21% oxygen in the absence of supplemental O2.

Inherent stiffness of disposable resuscitator

The inherent stiffness of the device makes it harder to feel lung compliance.

Oxygen delivery of disposable resuscitator

May deliver up to 100% O2 depending on supplemental gas flow rate, though it does not need a gas source.

Bag function in disposable resuscitator

The bag acts as a reservoir.

Resuscitator Valve Types

Diaphragm (leaf) type, Spring & disk/spring & ball type, and Duck bill valve.

Diaphragm (leaf) type valve

Made of flexible plastic that distorts as pressure is applied to allow flow to the patient.

Spring & disk/spring & ball type valve

Spring is compressed as the bag is squeezed, allowing flow to the patient.

Duck bill valve

Made of flexible plastic that distorts with pressure (similar to diaphragm type).

Positive End Expiratory Pressure (PEEP) in critically ill patients

May be necessary in critically ill pts.

PEEP valves mechanism

Use spring tension to maintain a set pressure in the lungs, even at end exhalation

PEEP monitoring

Need to confirm w/ a manometer to avoid barotrauma (pressure trauma)

Manometer alone for PEEP

May use a manometer alone to try and maintain PEEP w/o a valve (Flow inflating)

Mouth-to-Mask Ventilation Devices components

Soft-seal mask and a one-way valve (and/or filter) to separate pt & practitioner

Supplemental O2 in Mouth-to-Mask Ventilation

May have valve for supplemental O2; if not, YOU wear a NC

FiO2 with Mouth-to-Mask Ventilation

Supplemental O2 can increase FiO2 to 70%

Securing Mouth-to-Mask Ventilation Devices

Secure mask w/ both hands (A tight seal is very important)