Chapter 9- Airway management textbook notes

airway/ patent airway

movement of air into and out of the lungs

pharynx

throat

• divided into orpharynx, nasopharynx, laryngopharynx

oropharynx

OR-oh-FAYR-inkslaryngopharynx

area of the mouth joins the pharynx (second section)

nasopharynx

nuh-saa-fr-ingks

where nasal passages empty into the pharynx (top most section)

laryngopharynx or hypopharynx

lr·ing·gow·feh·ringks

structures surrounding the entrance to the trachea

• designed to provide structure to and protect the opening to the trachea (bellow oropharynx and surrounding the throat)

• point of division btw upper and lower airway

• supported and protected by cartilage

  • thyroid cartilage- protects the front (aka adams apple)

glottic opening

entry point into the larynx

• protected by epiglottis (protective flap)

  • epiglottis: seals off the trachea during swallowing

• also protected by vocal cords

lower ariway

trachea, bronchial passages and alveoli

• below glottic opening

• trachea breaks off into bronchi

• bronchia keep subdividing forming bronchioles

• bronchioles end at the alveoli

trachea

• lower airway

• protected by glottic opening/ yarynx

• contains 16 rings of cartilage

• branches off at the carina

• forms two mainstem bronchi

alveoli

tiny sacs in grape like bunches at the end of the airway

through them that co2 and o2 are diffused

pediatric airway

• shorter

• narrower

• less rigid

• mouth and nose are smaller

• tongue takes up more space

• newborns/infants breath through nose

• trachea is softer, more flexible, narrower

• chest wall is softer

• depend more on diaphragms than adults

bronchoconstriction

smooth muscles hanging of the internal diameter in the lower airway

• seriously impact ability to breath

• common in diseases like asthma

Stridor

• server restricted air movement in upper airway

• whistling like sound

• near obstruction

  • ie: toy, foreign body or swelling of upper airway tissues

hoarseness

• voice changes

• narrowing of upper airway

• ongoing airway issue

  • ie: swelling after a burn

  • ominous sign

• might notice a voice getting raspier as the swelling builds around vocal cords

snoring

• soft tissue of the upper airway creating partial obstruction

• for injury/illness indicates a decrease in mental status

  • airway muscle tone is diminished

• airway needs assistance to stay open

gurgling

• fluid obstructing the airway

• as air forced through liquid

  • ie: vomit, blood,

• suction is necessary

how to asses of possible head neck or spinal injury

• is mechanism of injury one that causes head neck or spine injury

• any injury at or above level of shoulders

• if bystanders tell you

positioning patient with airway risk

1. straighten legs position closer arm above patients head

2. grasp under further armpit

3. cradle head and neck and move patient onto one side

4. move onto back and reposition arm

• in an unconscious patient with threat of airway obstruction position them with head-elevated (sniffing position)

  • supine position head lifted 1.5-2 inches

• for pediatric (<4 yrs in this case)

  • head should also be up align patients ear to level of suprasternal notch

head tilt, chin lift maneuver

1. one hand on forehead fingertips under boney area of lower jaw

2. tilt the head

3. lift the chin and support the lower jaw. move jaw forward where lower teeth are touching upper teeth

4. don’t let mouth be closed, use thumb to pull back patients lower lip

don’t use if possible neck, head or spinal injury

jaw-thrust maneuver

• keep head, neck and spine as still as possible

  1. knell at top of head

  2. place one hand on each side of lower jaw

  3. push nagle of patients lower jaw forward

  4. retract patients lower lip to keep mouth open

  5. dont rotate patients head

airway adjuncts devices

move soft tissue in the upper airway

• oropharyngeal airway- oral airway (OPA)

  • only on patients who don’t have gag reflex

• nasopharyngeal airway (NPA)

• open airway manually before using

• dont push tongue into phaarynx

• suction ready

• maintain head tilt chin lift maneuver and montier airway

• be ready to provide suction

• remove airway if patient regains consciousness

• oropharyngeal airway- oral airway (OPA)

• only on patients who don’t have gag reflex

• curved device made of plastic that moves the tongue forward as it curves back to the pharynx

• size matters

• measure from corner of patient’s mouth to the tip of the ear lobe

• or from the center of patients mouth to the angle of the lower jawbone

  • if its too big- directs air into stomach

  • too small- won’t open airway

• for children/infants insert it straight not rotated

nasopharyngeal airway (NPA)

• can be used when there are oral injuries or when teeth are clenched

• should considered that it may enter the brain cavity if the basilar skull is fractured

• measure from patients nostril to tip of earlobe or angle of the jaw

  1. lube tube with water based lube

  2. push tip of nose upward and insert into airway

  3. dont force, gently twist

sunctioning

method of using a vacuum to remove airway obstructions

need:

• tubing

• suction tips

• suction catheters

• collection containers

• container of clean water

rules:

• try limiting suctioning to no longer than 10 seconds

• place the tip/catheter where you want to begin suctioning and suction on way out

• use appropriate infection practices

bulb syringe suctioning

common procedure in infants and small children

• infants are sensitive to vagal stimulation caused by catheter contact

• can respond with a slowing in the heart rate

special cases/consideration

• facial injuries- frequent suctioning may be required due to blood

• obstructions

• dental appliances