Chapter 10 Airway Management

Clinical Death

Happens immediately when the heart stops

Biological Death

Occurs approximately four to six minutes after the onset of clinical death.

-Oxygen was not being delivered to the brain, which leads to brain tissue death.

Hypoxia

Lack of oxygen in the body tissues.

Hypoxemia

Low levels of oxygen in the blood.

What are the two primary muscles for breathing?

The diaphragm and the intercostal muscles.

Accessory Muscle Use

Sign of respiratory distress.

Using abdominals, pecs , scalenes, and sternocleidomastoid muscles to assist in breathing.

Pertinent Positive

Presence of a sign or symptom that helps identify a patient's condition.

Pertinent Negative

Absence of a sign or symptom that helps identify a patient's condition.

OPA Name

Oropharyngeal airway

OPA Indication

Patient cannot protect airway, they will have a snoring sound when breathing. The patient is unconscious without a gag reflex

OPA Contraindication

Patent gag reflex.

OPA Size Measurement

Measure from ear to mouth

OPA Adult Insetion

90 to 180 degrees

OPA Pediatric Insertion

Straight in, or 90 degrees

OPA two ways to open patient mouth

Tongue Jaw Lift or Cross Finger

NPA Name

Nasopharyngeal airway

NPA Indication

Patient who cannot protect airway with a gag reflex

NPA Contraindications

Patient with facial trauma and or skull fracture (if you insert an NPA with a patient with a skull fracture, there is a chance you could enter the cranial vault)

NPA Size Measurement

From the ear to the nose

NPA Insertion

Largest nostril bevel to the septum

Suction Indication

Gurgling sound - sign fluid is in the upper airway

Suction Limitations

Cannot suction out large particles, so manual before mechanical: turn the patient to the side first and get out any large chunks

When do you stop suction

When the heart rate drops, it has been longer than 15 seconds, or suctioned everything out

Suction Oral Pressure Adult

300mmHg

Suction Oral Pressure Pediatric

80-120mmHg

Suction Time Limits: Oral suction

15 seconds then stop, or if the heart rate drops stop then (whichever comes first)

If heart rate drops, stop suction and give oxygen until heart rate returns

-You can only suction on the way out

Oral Suction Names

Rigid, hard, tonsil tip, tonsil sucker, yaunker

Spontaneous Respirations

Breathing that occurs without assistance.

Three ways to identify an oxygen cylinder

Green, 2-5 pin index, stamped oxygen on the tank

Three ways to identify a regulator

O ring, pressure gauge in PSI, flow meter in LPM

Oxygen tank keys are made of?

Plastic or aluminum

Maximum Residual Pressure

2000psi

Minimum Residual Pressure

200psi

When is oxygen indication?

Patient's whose oxygen is less than 94% (but remember, treat the patient and not the number)

Patients in respiratory distress/failure

Patient's with inhaled overdoses

Patient's who are having an allergic reaction

Pregnant patient's with complications (breach)

Non-Rebreather Flow Rate

10-15 LPM

High flow device

Non-Rebreather Oxygen Concentration

80-95%

How full must a Non-Rebreather reservoir be before putting on a patient?

At least 50% full

Nasal Cannula Flow Rate

1-6 LPM

Low flow device

Nasal Cannula Oxygen Concentration

22-44%

With every increase of 1LPM on a NC, means a 4% increase in oxygen concentration

1LPM = 22%, 2LPM = 26% etc

Mouth to Mask: How to open patient's airway

Head tilt chin lift (if no trauma)

Mouth to Mask oxygen concentration on room air

16%

Mouth to Mask Flow Rate

15LPM

Mouth to Mask Oxygen Concentration on oxygen

50-60%

Mouth to Mask: How long do you deliver a breath

Over 1 second

Each breath should deliver enough air to make the chest rise and fall for what would be normal for that patient (an obese patient may require a more forceful breath to get good chest rise)

Mouth to Mask: How often do you give a breath for an adult

Every 5 to 6 seconds

Mouth to Mask: How often do you give a breath to a pediatric?

Every 3 to 5 seconds

What is Gastric Distention?

Air in the stomach due to poor ventilations or ventilations that are done incorrectly

3 causes of gastric distention

Too forceful/fast of breaths, too much air in the lungs, and not opening the airway

5 causes for poor masks seals

Fluid on the face

No teeth

Facial Fractures

Facial Hair

Facial Deformities

Full name of BVM

Bag-Valve-Mask

AKA AMBU Bag

Clamp used for one person use of BVM

C/E Clamp

BVM is best used with how many rescuers?

2

BVM oxygen concentration on room air

21%

BVM Flow Rate

15 LPM

BVM oxygen concentration without reservoir on oxygen

50-60%

BVM oxygen concentration with reservoir on oxygen

80-100%

Chocking Patient

If they can pass air, encourage them to cough. If they have a full obstruction, do abdominal thrusts until the obstruction clears or the patient passes out. If they go unconscious begin CPR