Airway Management and Equipment (Quiz 2)

What are the main functions of the human airway?

1. Protection from aspiration

2. Conduction - Moves air for oxygen intake and CO₂ removal

3. Air Conditioning – Warms and humidifies the air

What do we do to the human airway? Why?

1. Protection from aspiration

2. Conduction

• Support O2 intake

• Support CO2 excretion

• Supply and remove anesthetic gases and

vapors

3. Air conditioning

• Minimize heat loss

• Minimize water vapor loss

When managing the human airway, we must avoid compromising its ____________

Natural defenses against microorganisms

How are wall oxygen and gas outlets secured?

D.I.S.S. (Diameter Index Safety System)

How are oxygen tanks and other gas tanks connected safely?

P.I.S.S. (Pin Index Safety System)

U.S. Medical Gas Color Codes for:

1. O2

2. N2O

3. Air

4. CO2

1. Green

2. Blue

3. Yellow

4. Gray

What are the steps to ensure oxygen delivery from the wall outlet?

1. Ensure a proper connection by gently tugging the tubing

2. Set the desired flow and make sure the ball is freely moving

Where do you read the flow rate on a flowmeter?

At the center of the ball in the flowmeter tube

They are the most common and inexpensive type of oxygen delivery device

Low-flow oxygen devices

How do low-flow oxygen devices deliver oxygen?

They supply oxygen at a fixed flow rate and make up only a part of the inspired air

→ Mixed with room air

Who are low-flow oxygen devices best suited for?

Patients with a stable breathing pattern

How do high-flow oxygen devices deliver gas?

They supply inspired gas at a preset FiO₂, either through continuous high flow or a large reservoir

Effect of changes in breathing patterns on FiO₂ in high-flow devices

FiO₂ is not affected by abnormal or changing breathing patterns

High-flow devices are indicated for patients who require

1. Consistent FiO₂

2. Larger inspiratory flows of gas (>40L/min)

What are examples of low-flow oxygen devices?

1. Nasal cannulas

2. Simple face masks

3. Partial rebreathing masks

4. Nonrebreathing masks

5. Tracheostomy collars

What are examples of high-flow oxygen devices?

1. T pieces

2. Aerosol masks

3. Venturi masks

4. High-Flow Nasal Cannulas

Nasal cannula FiO2 range

0.24 - 0.44

Each 1 L/min increase in oxygen flow via nasal cannula raises FiO₂ by about ___%

4%

Flow rate range for a nasal cannula

0.25 - 6 L/min

When is humidification needed with a nasal cannula?

≥ 5L/ min

Nasal cannula limitations

1. Nasal trauma due to:

→ Prolonged use

→ Pressure from prongs

2. Flow becomes turbulent at high flow rates

True or false: Nasal cannulas have a predictable FiO₂

False

→ FiO₂ is unpredictable for nasal cannulas

A disposable, lightweight plastic mask that covers the nose and mouth

Simple face mask

How much oxygen does the space inside the simple face mask (reservoir space) typically hold?

100 - 200 mL

What is the function of the two side ports on a simple face mask?

1. Allow room air to enter

2. Allow exhaled gases to exit

Does a simple face mask contain any valves?

No

What is the minimum gas flow required for simple face masks to limit rebreathing of CO₂?

5 L/min

Flow rate range for simple face masks

5 - 8 L/min

Simple face mask FiO₂ range

0.40 - 0.60

Who are simple face masks not suitable for?

1. Profoundly hypoxic

2. Tachypneic (rapid breathing)

3. Unable to protect their airway from aspiration

What are common clinical uses for simple face masks?

1. Medical transport

2. Therapy in PACU or ED

A simple face mask with an attached reservoir bag

Partial rebreather mask

What is the function of the side ports on a partial rebreather mask?

1. Let room air in

2. Let exhaled air out

Why is it called a partial rebreather mask?

Part of the patient's exhaled tidal volume (Vₜ) refills the bag

What should be avoided during inspiration when using a partial rebreather mask?

The reservoir bag should not fully collapse, as this can lower FiO₂

Partial rebreathing mask should have a fresh gas flow of ___________

≥ 8 L/min

Partial rebreather mask FiO₂ range

0.60 - 0.80

What makes non-rebreather masks different from partial rebreather masks?

Two valves (one valve on each side)

→ Permits the venting of exhaled gases

→ Prevents room air entrainment

Third valve

→ Between the mask and the reservoir bag

→ Prevents exhaled gases from entering the bag

Non-rebreather mask reservoir bag capacity

600 - 1000 mL

→ Same for partial rebreather mask

What should be avoided during inspiration when using a non-rebreather mask?

The reservoir bag should not fully collapse, as this can lower FiO₂

Non-rebreather mask oxygen flow rate

10 - 15 L/min

Non-rebreather mask FiO₂ range

0.80 - 0.90

→ Can be 100%

Non-rebreather masks are indicated for patients with

Significant hypoxemia but relatively normal spontaneous minute ventilation

→ Patient has low oxygen levels in their blood (hypoxemia), but they are still breathing a normal amount of air per minute on their own

What are common clinical uses for partial rebreather masks and non-rebreather masks?

Therapy in PACU

Used to deliver humidified oxygen to tracheostomy patients

Tracheostomy collar

True or false: FiO₂ delivery is unpredictable with tracheostomy collars

True

For tracheostomy collars, FiO₂ delivery is based on

Ventilatory (breathing) pattern

Used to deliver humidified O2 to patients who are not tolerating a face mask or nasal cannula well

Face shield

True or false: FiO₂ is unpredictable for face shields

True

→ Based on ventilation

Face shield is good for patients who suffer from

1. Claustrophobia

2. Facial injury

High-flow oxygen systems are called fixed performance systems because

They deliver a consistent and precise FiO₂

True or false: High flow oxygen systems cannot provide entire inspiratory atmosphere to the patient

False

→ High flow oxygen systems can provide entire inspiratory atmosphere to the patient

→ It means they provide the entire volume of gas the patient inhales

Flow rate range for high flow oxygen systems

30 - 50 L/min

True or false: Humidity can be controlled in high-flow oxygen systems

True

Venturi mask provides predictable and reliable FiO₂ values of

0.24 - 0.50

How does a Venturi mask deliver a specific and consistent FiO₂?

Bernoulli principle and constant pressure-jet mixing

Fast oxygen flow creates low pressure that pulls in room air (air entrainment), which is mixed in fixed proportions

→ Venturi effect

What types of FiO₂ control do Venturi masks offer?

Fixed FiO₂ model: Color-coded adapters for specific oxygen concentrations

Variable FiO₂ model: Adjustable dial to set graded FiO₂ levels

Venturi mask is often used for patients with

1. COPD

2. Asthmatics

Why should aerosolized water be avoided in some asthmatic patients?

It can irritate the airways and may exacerbate or trigger bronchospasm

Oral airway obstruction is relieved by

1. Jaw thrust

2. Repositioning the head

What can we use to support an airway?

1. Jaw thrust

2. Repositioning the head

→ Head Tilt

→ Chin lift

→ Sniffing position

Two types of TMJ movements

1. Rotational Movement

→ Open and close your mouth

2. Translational Movement

→ Sliding motion of the jaw

True or false: Mandibular advancement/jaw thrust can be initiated only after translational movement has occurred

True

Triple airway maneuver

Head tilt, jaw thrust, and open mouth

Two types of oral airways

Guedel and Berman

OAW can help with

1. Edentulous patients

2. Airway suctioning

3. Preventing ETT biting and occlusion

→ Can cause tooth damage

4. Airway patency

Which OAW has side air channels?

Berman

Which OAW has a single central lumen?

Guedel

OAW sizing

→ Flange at the corner of the mouth

→ Tip at jaw angle

________ should always be used before OAW insertion

Tongue depressor

What risks are associated with using an oral airway (OAW) in an inadequately sedated patient?

1. Vomiting

2. Laryngospasm

Complications if OAW is too long or too short

Too long: Obstruct larynx by forcing down epiglottis

Too short: Pushes tongue into airway

____________ is used when oral airway placement is difficult

Nasal airway (NAW)

NAW sizing

The distance from the tip of the nose to the meatus of the ear

True or false: For NAW, the width of the device is more important in determining the size than the length

False

→ For NAW, the length of the device is more important in determining the size than the width

During NAW insertion a _________ can be used to reduce bleeding

Vasoconstrictor nasal spray

When should NAW be avoided?

1. Known nasal airway occlusion

2. Known or suspected basilar skull fractures

Facilitates the delivery of O2 or anesthetic gas from a breathing system to a patient

Face masks

Face masks: Avoid pressure greater than

20 cm H₂O

EC grip

→ The thumb and index finger form a “C” around the mask to hold it in place

→ The other three fingers (3, 4, 5) form an “E” along the jawline

Suction catheters may be either _________ or _______ based on application

1. Rigid (Yankauer)

2. Soft

Soft suction can cause vagal stimulation causing

Bradycardia

What are the normal values for each of the following in patients suitable for low-flow oxygen devices?

1. Minute ventilation

2. Breathing frequency

3. Tidal Volumes

4. Normal inspiratory flow

1. ≤ 8 to 10 L/min

2. ≤ 20 breaths/min

3. ≤ 0.8 L

4. 10-30 L/min

________ can be used as a substitute for an oral airway

Soft bite block