CH 16 Airway Management

What is the primary goal of airway management?

To establish and maintain a patent airway, ensuring effective oxygenation and ventilation.

What are the vital functions of the respiratory system?

To bring in oxygen and eliminate carbon dioxide.

What is a major cause of preventable death in the prehospital setting?

Failure to manage the airway.

What are the key components of appropriate airway management?

Open and maintain the airway, recognize and treat obstructions, assess ventilation and oxygenation status, administer oxygen, and provide ventilatory assistance.

What anatomical structures are included in the upper airway?

The tongue, uvula, and pharynx.

What is the function of the pharynx?

It extends from the nose and mouth to the esophagus and trachea.

What is the significance of the cricothyroid membrane?

It is a site for emergency surgical and nonsurgical access to the airway.

What is the glottis?

The space between the vocal cords.

What is the process of ventilation?

The physical act of moving air into and out of the lungs, including inhalation and exhalation.

What is oxygenation?

The process of loading oxygen molecules onto hemoglobin in the bloodstream.

What is respiration?

The process of exchanging O2 and CO2, which includes external (pulmonary) and internal (cellular) respiration.

What are early signs of hypoxia?

Restlessness, irritability, tachycardia, and anxiety.

What are late signs of hypoxia?

Mental status changes, a weak pulse, and cyanosis.

What does V/Q mismatch refer to?

A condition where air and blood flow are not directed to the same place at the same time, leading to inadequate gas exchange.

What are intrinsic factors affecting ventilation?

Infection, allergic reactions, and unresponsiveness, with the tongue being a common obstruction.

What are extrinsic factors affecting ventilation?

Trauma and foreign body airway obstruction.

What is hypoventilation?

A condition where carbon dioxide production exceeds elimination.

What is hyperventilation?

A condition where carbon dioxide elimination exceeds production.

How do high altitudes affect oxygenation?

They decrease the partial pressure of oxygen in the ambient air.

What internal factors can reduce oxygen supply?

Conditions that reduce surface area for gas exchange, such as nonfunctional alveoli or fluid in the alveoli.

What is the impact of circulatory compromise on oxygenation?

It leads to inadequate perfusion and insufficient delivery of oxygen to tissues.

How do heart conditions affect oxygen delivery?

They reduce blood flow to tissues, impacting oxygen supply.

What role does shock play in oxygen delivery?

It inhibits the efficient delivery of oxygen to tissues.

What is the consequence of inadequate external respiration?

It leads to insufficient oxygen supply to cells.

What is the relationship between infection and oxygen supply?

Infection increases metabolic needs and disrupts homeostasis, potentially reducing oxygen supply.

What is the effect of hypoglycemia on oxygen levels?

It decreases both oxygen and glucose levels in the body.

What can disrupt acid-base balance?

Hypoventilation, hyperventilation, and hypoxia.

What systems help maintain acid-base homeostasis?

The respiratory and renal systems.

What is a consequence of inhibited respiratory function?

Acidosis can develop.

What can occur if the respiratory rate is too high?

Alkalosis can develop.

What indicates poor tissue perfusion?

Hemorrhagic and vasodilatory responses.

What is the normal range for breathing rate?

Between 12 and 20 breaths per minute.

What are signs of inadequate breathing?

Breathing rate fewer than 12 or more than 20 breaths/min, cyanosis, and preferential positioning.

What should be assessed to recognize inadequate breathing?

Airway patency, breathing rate, and quality of breath sounds.

What are potential causes of inadequate breathing?

Severe infection, trauma, brainstem injury, and airway obstruction.

What are the steps in airway management?

Open the airway, clear the airway, assess breathing, and provide appropriate interventions.

What does auscultation of breath sounds help determine?

The quality of airflow and presence of abnormal sounds.

What are abnormal breath sounds?

Wheezing, rhonchi, crackles, stridor, and pleural friction rub.

What does pulse oximetry measure?

Oxygen saturation of hemoglobin (Hb).

What is the normal oxygen saturation level?

Greater than 95%.

What can cause erroneous readings in pulse oximetry?

Bright ambient light, patient motion, poor perfusion, and nail polish.

What does arterial blood gas analysis evaluate?

pH, PaO2, HCO3−, base excess, and SaO2.

What does PaCO2 indicate?

Effectiveness of ventilation.

What does a peak expiratory flow measurement evaluate?

Bronchoconstriction.

What does increasing peak expiratory flow indicate?

The patient is responding to treatment.

What does decreasing peak expiratory flow indicate?

The patient's condition is deteriorating.

What factors can affect peak expiratory flow rates?

Sex, height, and age.

What is the normal inspiratory/expiratory ratio?

1:2.

What is a sign of respiratory distress in a patient?

Use of accessory muscles and labored breathing.

What is the significance of assessing for paradoxical motion?

It indicates potential respiratory distress or injury.

What are protective reflexes to evaluate in a patient?

Coughing, sneezing, gagging, and sighing.

What does a systolic blood pressure drop during inhalation indicate?

Pulsus paradoxus.

What should be noted during the assessment of breathing?

Position, chest rise/fall, skin color, and breath sounds.

What does ETCO2 assess?

It detects carbon dioxide in exhaled air.

What is the normal range for ETCO2?

35-45 mm Hg

What does capnography indicate?

Adequacy of perfusion, effectiveness of chest compressions, and return of spontaneous circulation (ROSC).

What is expected with inadequate ventilations in ETCO2 readings?

An increased reading.

What ETCO2 reading is expected with hyperventilation?

A low reading.

What generates ETCO2 during chest compressions?

Perfusion that resumes CO2 production.

What can cause low ETCO2 despite adequate chest compressions?

Severe acidosis or minimal CO2 return to the lungs.

What are the types of ETCO2 monitors?

Colorimetric, digital, and digital/waveform.

What does a capnometer provide?

A numeric reading of exhaled CO2.

What does a capnographer provide?

A graphic representation of exhaled CO2.

What does waveform capnography provide?

Real-time CO2 information and displays a graphic waveform.

What is the purpose of waveform duration in capnography?

It indicates the duration of ventilation.

What does the space between waveforms in capnography indicate?

The respiratory rate.

What are key features of a normal capnographic waveform?

Contour, baseline level, and rate/rise of carbon dioxide level.

What are the phases of a normal capnographic waveform?

Phase I (A-B): Initial exhalation; Phase II (B-C): Expiratory upslope; Phase III (C-D): Alveolar plateau; Phase IV (D-E): Inspiratory downstroke.

What indicates hypoventilation in capnography?

Tall waveforms and high ETCO2 values.

What indicates hyperventilation in capnography?

Small waveforms and low ETCO2 values.

What are the uses of waveform capnography in non-intubated patients?

To assess pathologic processes causing pulmonary air trapping and gauge treatment effectiveness.

What is essential for airway management?

A patent airway.

What should be done for unresponsive patients found in a prone position?

Move them to a supine position and assess for breathing.

What is the preferred technique for opening the airway of an unresponsive patient without trauma?

Head tilt-chin lift maneuver.

What are the indications for the head tilt-chin lift maneuver?

Unresponsive patient, no cervical spine injury, unable to protect airway.

What are the contraindications for the head tilt-chin lift maneuver?

Responsive patient or possible cervical spine injury.

What are the advantages of the head tilt-chin lift maneuver?

No equipment required and noninvasive.

What are the disadvantages of the head tilt-chin lift maneuver?

Hazardous to patients with spinal injury and no protection from aspiration.

What is the technique for the head tilt-chin lift maneuver?

Apply backward pressure on the forehead and lift the chin upward.

What is the jaw-thrust maneuver used for?

To open the airway in suspected cervical spine injury cases.

What are the contraindications for the jaw-thrust maneuver?

Resistance to opening the mouth.

What are the advantages of the jaw-thrust maneuver?

Can be used with cervical spine injury and requires no special equipment.

What is the disadvantage of the jaw-thrust maneuver?

Difficult to maintain if the patient becomes responsive or combative.

What is the tongue-jaw lift maneuver commonly used for?

To open the airway for suctioning or inserting an oropharyngeal airway.

What is the technique for the tongue-jaw lift maneuver?

Place one hand on the forehead and lift the jaw straight up with the other hand.

What is the primary purpose of suctioning?

To remove material from the mouth or throat quickly and efficiently.

What can happen if you ventilate with secretions in the mouth?

It can force material into the lungs.

What is the next priority after manually opening the airway?

Suctioning.

What types of suctioning equipment are available?

Fixed or portable suctioning units, hand-operated suctioning units with disposable canisters, and mechanical or vacuum-powered suction units.

What type of tubing should be readily accessible for suctioning?

Wide-bore, thick-walled, nonkinking tubing.

What are the preferred suction catheters for infants and children?

Soft plastic, nonrigid catheters, such as tonsil-tip catheters.

What should you do after suctioning?

Continue ventilation and oxygenation.

What is a critical technique when using soft-tip catheters?

Lubricate when suctioning the nasopharynx.

What should you never do with a suction catheter?

Never insert a catheter past the base of the tongue.

What is the purpose of airway adjuncts?

To help maintain patency in an unresponsive patient after manually opening and suctioning.

What is an oropharyngeal airway?

A curved, hard plastic device that fits over the back of the tongue.

When should an oropharyngeal airway be inserted?

In unresponsive patients who have no gag reflex.

What are the contraindications for using an oropharyngeal airway?

Responsive patients and patients with a gag reflex.

What is a disadvantage of the oropharyngeal airway?

It does not prevent aspiration.

What is a nasopharyngeal airway?

A soft, rubber tube inserted through the nose.