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patent airway

clear, open airway

upper airway

air enters through mouth and nose and is humidified as it passes through the nasal passage.

posterior and inferior to mouth and nose

pharynx

3 regions of the pharynx

1. oropharynx: where the oral cavity meets the pharynx

2. nasopharynx: where the nasal passage meets the pharynx

3. laryngopharynx: provides structure and protects the entrance of the trachea

upper-lower airways boundary

glottis opening (level of the vocal cords) define the boundary

point of division between the upper and lower airway

laryngopharynx

glottic opening

entry point to the larynyx, protected by the epiglottis

epiglottis

superior to the glottic opening, seals off the trachea during gag reflex/swallowing

thyroid cartilage

aka adam’s apple. protects the layrnyx

lower airway start

glottic opening

lower airway

trachea, bronchioles, alveoli

airflow of the lower airway

air enters the trachea form the glottic opening, through the mainstream bronchi, into the bronchioles, and then to the alveoli where gas exchange takes place

trachea cartilage

trachea is protected by 16 rings of cartilage, 1st ring (cricoid) extends 360, the rest extend 3/4th and connect posteriorly to smooth muscle

why are air passages connected to muscle and supported with cartilage?

allows bronchioles to change their diameter in response to certain stimulation

gas exchange

alveoli are surrounded by pulmonary capillaries, they exchange O2 and CO2

pediatric airway

immature neck muscles, structures and are shorter and less rigid, mouth is smaller, tounge is bigger, softer more flexible trachea, softer chest wall, children depend on there diaphragms more

intact muscle tone

normal state in tension in a muscle

effects of loss of muscle tone and bronchoconstriction

airway may collapse

in the lower airway smooth muscle may constrict and decrease the internal diameter in the airway—-can create restriction of air flow

stridor

caused by severe restriction in the upper airway, narrow air passage

high pitched/ whistling sounds

can be caused by foreign bodies or infection

hoarseness

caused by swelling after a burn

voice may begin normal but become raspy as swelling builds up

snoring

soft tissue in the upper airway blocking airflow

indicates muscle tone is diminished and airway needs assistance to remain open

gurgling

sound of fluid blocking the airway

immediate suction is necessary

4 sounds when airway is restricted

stridor, hoarseness, snoring, gurgling

airway assessment

ask the patient to speak, the sound of there voice should be enough to confirm an open airway

opening the airway

if patient is mentally impaired or unconscious, lay them supine

*airway and breathing have priority over spinal precautions

indications of head, neck, or spinal injury

1. cause of the injury (i.e car accident)

2. any injury et above the shoulders

3. info from family or bystanders

protocols for patients with open but threatened airways

conscious may sit however they fee comfortable,

unconscious patients need to be in head elevating sniffling position

head elevated sniffling position

slight elevation and anterior positioning of the head better aligns airway structures

place 1.5-2in of padding posterior to the neck. ear should be at the same level as the superior part of the sternum

2 maneuvers for correcting airway blockage

head-tilt chin-lift: corrects blockage by tilting the head and lifting the chin. NOT spinal injury safe

jaw thrust maneuver: corrects blockage by moving the jaw forwards without lifting the neck, head, or spine. spinal injury safe

airway maneuver purpose

correct the position of the tounge and move the epiglottis away from glottic opening

severe chocking

trachea is completely blocked, no air is moving

intervene immediately

non-severe choking

trachea is partially blocked, allows some airflow, do not intervene

conscious, choking infants

intervene immediately, place the baby prone with the head lower than the body, support the head

5 back slaps between should blades and then 5 chest thrusts (supine)

unconscious choking

provide CPR

when to use airway adjuncts

when basic maneuvers are not enough to keep a patients airway open

oropharyngeal and nasopharyngeal

oropharyngeal airway

curved devices inserted through the mouth into the pharynx

never use them on patients with a gag reflex

nasopharyngeal airway

flexible breathing tube inserted through the nostril into the pharynx

finding the correct oropharyngeal size

measure from the mouth to the tip of the earlobe

if too big, the distal tip will send air to the stomach

if too small, tongue will not be paced properly

when/when not to use a nasopharyngeal airway

can be used when teeth are clenched or oral injury is present

cannot be used when there is a bisilar skull fracture or nasal trauma

pediatric safe, does not simulate gag reflex

superglottic airway

last resort, not gag reflex friendly, used when an adjunct is needed for a long period of time.

suctioning

vacuum device used to remove fluid from the airway

gravity/recovery position is the best way to remove fluid through the mouth

lateral recumbent position may also help

ambulance-mounted suction units

electrically power, require 30mL per min at 300mmHg

portable suctioning

must be thick-walled to allow large chunks to pass through

rigid pharyngeal tip allows for easy suctioning of the mouth + pharynx, cannot be used on unconscious patients, may trigger gag reflex

can only be used for a few seconds

suction cathers

flexiable tubes measured using a number and “french”

used when a rigid tip cannot be used

collection container

used to collect suctioned material

container of clean (sterile) water

used to clean matter blocking the tube, place the suction tip, cather into the water

pediatric suctioning

same as adults, infants may be sensitive to suctioning and it may slow there heart rates, suction as fast as possible

bulb syringe suctioning is most common for infants

limiting suctioning

limit all suctioning to no more than 10 seconds

longer suctioning can cause hypoxia or vagal response

if the patient keeps vomiting, do not stop

after suctioning

immediately administer any necessary ventilation/oxygen

inserting a cather

place where you want to begin suctioning

measured from the corner of the mouth to the earlobe

keep the patient on there side (best way to suction)

facial injuries

blood supply to the face is rich, may require frequent suctioning

obstructions

food and forge in bodies too large to be suctioned must be removed manually

dental appliances

dentures should be left in place but partial dentures may be removed if they dislodge/endanger the airway