Unit 1 Exam - BVM and Airway Adjuncts (OPA, NPA, and LMA)

What are the 6 main causes of upper airway obstruction?

Tongue; edema; bleeding; secretions; foreign substances; laryngospasm.

What is the MAIN cause of upper airway obstruction?

The tongue falling back against the posterior wall of the pharynx.

What are examples of foreign substances that can cause upper airway obstruction?

Foreign bodies, false teeth, and vomitus/vomit.

What is laryngospasm?

A transient and reversible spasm of the vocal cords that causes temporary loss of speech or ability to breathe.

What are the signs of partial airway obstruction?

Crowing or gasping sounds on inspiration; difficulty or inability to cough; increasing respiratory difficulty; good-to-poor air exchange depending on severity; exaggerated chest and abdominal movement without comparable air movement; cyanosis depending on severity.

What is another term for crowing or gasping sounds on inspiration?

Stridor.

What are the signs of complete upper airway obstruction?

Inability to talk; increased respiratory difficulty with no air movement; cyanosis; sternal, intercostal, and epigastric retractions; accessory muscle use of the neck and chest; extreme panic; unconsciousness and respiratory arrest if the obstruction is not removed.

What happens if a complete airway obstruction is not removed?

Unconsciousness and respiratory arrest can occur.

How is a conscious patient with a partial airway obstruction treated?

Monitor the patient closely and allow them to try to relieve the obstruction on their own.

How is a conscious patient with a complete airway obstruction most likely caused by food or a foreign object treated?

Abdominal thrusts are performed until the object is dislodged.

How is an unconscious patient with a partial or complete airway obstruction most likely caused by the tongue treated?

Head-tilt/chin-lift is used to move the tongue forward and help relieve the obstruction.

When is the head-tilt/chin-lift maneuver used?

In most cases to restore the airway.

When is the jaw-thrust maneuver used?

When a neck injury may be present.

What is breathlessness/ventilatory compromise indicated by?

No chest movement, no normal breath sounds, or only gasping/agonal breathing.

How long should evaluation for breathlessness take?

No longer than 3–5 seconds.

What are the methods of rescue ventilation listed in the slides?

Mouth-to-mouth, mouth-to-nose, mouth-to-stoma, and mouth-to-mask.

When is mouth-to-nose ventilation used?

When mouth-to-mouth ventilation cannot be performed, such as with a baby or small child, trismus, traumatic jaw or mouth injury, or inability to maintain a tight seal with the lips.

When is mouth-to-stoma ventilation used?

In patients with tracheostomies or laryngectomies.

What does BVM stand for?

Bag-valve-mask.

What is the purpose of a BVM?

To provide manual positive-pressure ventilation.

When is a BVM used?

When ventilation is inadequate or absent.

What can a BVM be used with?

A mask or an artificial airway.

What sizes are BVMs available in?

Infant, pediatric/child, and adult sizes.

Why are BVMs produced in different sizes?

To help prevent lung injury.

What does a BVM allow the clinician to assess?

Lung compliance.

When is a BVM most effective?

When there is a proper mask seal.

What technique improves the mask seal when available?

The two-person technique.

What are the 3 uses of manual resuscitators?

Manual ventilation; hyperinflation of the lungs before tracheal suctioning; transport of a patient who requires artificial ventilation.

What is a self-inflating BVM?

A manual resuscitator that self-inflates and must be squeezed to deliver a breath to the patient.

Can a self-inflating bag be used with or without oxygen?

Yes.

How often should a self-inflating BVM be squeezed for an adult?

Approximately once every 5–6 seconds.

How often should a self-inflating BVM be squeezed for an infant or child?

Approximately once every 3 seconds.

What is a flow-inflating resuscitation bag also called?

An anesthesia bag or non-self-inflating resuscitation bag.

What does a flow-inflating resuscitation bag require?

Continuous gas flow to remain inflated.

Does a flow-inflating bag self-inflate?

No.

What happens to a flow-inflating bag if a good mask seal is not maintained?

The bag deflates.

What can a patient do through a flow-inflating system?

Breathe spontaneously through the system.

Where are flow-inflating bags commonly used?

Anesthesia and neonatal/pediatric patients.

What advantage does a flow-inflating bag provide?

Better control of pressure and volume.

What can be felt when compressing a flow-inflating bag?

Lung compliance and resistance.

What is the function of the exhalation valve and ports?

To prevent rebreathing of exhaled air.

How can positive end-expiratory pressure (PEEP) be achieved with a BVM?

By using a spring-loaded or magnetic PEEP valve on the exhalation port.

What should be done to achieve the highest possible FiO₂ with a BVM?

Attach supplemental oxygen, use a functioning oxygen reservoir, set O₂ flow at 10–15 L/min, maintain a tight mask seal, deliver each breath over approximately 1 second, allow adequate/longest possible bag refill time, and ventilate only until visible chest rise.

What oxygen flow should be used with a BVM to maximize FiO₂?

10–15 L/min.

What is the importance of the oxygen reservoir when using a BVM?

It helps provide the highest possible delivered FiO₂.

What happens to delivered FiO₂ if a reservoir is not attached to the BVM?

Approximately 40–50% FiO₂.

What are the 3 criteria that ensure the highest delivered oxygen levels possible with a BVM?

Always use a reservoir attachment; use the highest flow rate of 10–15 L/min; use the longest possible bag refill time.

What does the longest possible bag refill time mean?

A slower ventilation rate.

How long should each BVM breath be delivered?

Approximately 1 second.

How far should a BVM breath be delivered?

Only until visible chest rise.

During respiratory arrest, how often should an adult receive a BVM breath?

One breath every 5–6 seconds.

What are the hazards and complications of BVM ventilation?

Mask leaks/poor seal; gastric insufflation; regurgitation and aspiration; barotrauma from excessive pressure/volume; hyperventilation; equipment malfunction.

What can cause leaks during BVM ventilation?

An improperly fitted face mask or an inadequately filled ET tube cuff.

What can cause BVM equipment malfunction?

Sticking or dirty valves, missing parts, improper assembly, or dirty valve mechanisms.

What can gastric insufflation lead to?

Regurgitation and aspiration.

How can gastric insufflation be minimized according to the reading notes?

By providing low-to-moderate inspiratory flows below 30 L/min.

What can cause barotrauma during BVM ventilation?

Excessive pressure or volume.

What complication may result from poor BVM ventilation technique?

Hyperventilation/poor ventilation.

Are there absolute contraindications to BVM ventilation when emergency ventilation is required?

No. There is no absolute contraindication when emergency ventilation is required.

What factors can make BVM ventilation difficult or ineffective?

Poor mask seal/facial trauma; airway obstruction; difficult airway anatomy; inability to maintain airway patency.

What should be considered if adequate BVM ventilation cannot be achieved?

An advanced airway.

What are the two types of basic pharyngeal airways?

Oropharyngeal airway (OPA) and nasopharyngeal airway (NPA).

What is the purpose of a pharyngeal airway?

To help restore airway patency and improve ventilation, especially when using a bag-mask device.

What is an OPA?

An oropharyngeal airway that maintains a patent airway by lying between the base of the tongue and posterior wall of the pharynx, preventing the tongue from falling back and occluding the airway.

Who should receive an OPA?

A deeply unresponsive/unconscious patient with no gag reflex.

Why is an OPA used only in an unconscious patient with no gag reflex?

A conscious patient would gag on the airway, potentially leading to aspiration.

What does the flange on an OPA do?

Prevents the device from being inserted or pushed too far into the airway.

What is another benefit of an OPA?

It allows suctioning while in place.

What should be done if an OPA patient becomes responsive and starts fighting the airway?

Remove the OPA immediately.

Why should an OPA be easily removable?

To prevent vomiting and aspiration if the patient becomes conscious.

Why should an OPA never be taped in place according to the textbook notes?

The airway must be easily removable to prevent vomiting and aspiration if the patient becomes conscious.

How is an OPA sized?

Measure from the corner of the lip to the angle of the jaw.

What are the 5 steps of OPA insertion?

Measure from corner of lip to angle of jaw; remove foreign substances from mouth; hyperextend the neck; open the mouth using the cross-finger technique and insert with the tip toward the roof of the mouth; observe the airway passing the uvula and rotate it 180 degrees.

What technique is used to open the mouth during OPA insertion?

Cross-finger technique.

In which direction is the OPA initially inserted?

With the tip pointing toward the roof of the mouth.

How far is the OPA rotated during insertion?

180 degrees.

What are the hazards of an OPA?

Gagging/fighting the airway; improper insertion causing airway obstruction; an airway that is too large; an airway that is too small.

What can happen if an OPA is inserted improperly?

The base of the tongue may be pushed into the back of the throat, obstructing the airway.

What can happen if an OPA is too large?

The epiglottis may be pushed into the laryngeal area.

What can happen if an OPA is too small?

It may be aspirated or may be ineffective in relieving the obstruction.

What are the contraindications to an OPA?

Conscious or semiconscious patients with an intact gag reflex; foreign body obstruction; oromaxillary/mandibular trauma.

Why may an OPA be used in an unconscious, orally intubated patient?

To prevent the patient from biting the endotracheal tube.

What are Berman airways made of?

Hard plastic.

Where is a suction catheter guided in a Berman airway?

Through a groove on either side that guides the catheter toward the glottic area.

What are Guedel airways made of?

Soft and pliable material.

Where is a suction catheter guided in a Guedel airway?

Through an opening through the middle of the airway into the glottic area.

What is an NPA?

A soft airway adjunct inserted into the nasal passageway that maintains a patent airway by lying between the base of the tongue and posterior wall of the pharynx.

What are other names for an NPA?

Nasal trumpet, nasal airway, or nose hose.

What is the NPA constructed of?

Soft, pliable rubber.

What patients can tolerate an NPA?

Conscious or semiconscious patients, including patients who cannot tolerate an OPA.

What is an advantage of an NPA over an OPA?

It can be used in patients with an intact gag reflex, trismus, and oral trauma.

What can a conscious patient do while tolerating an NPA?

Eat, drink, and speak.

What is the most common use of an NPA?

To facilitate nasotracheal suctioning.

What is the major contraindication to NPA use?

Suspected basilar skull fracture.

How is an NPA sized?

Measure from the tip of the nose to the earlobe.

What should the outside diameter of the NPA be?

Equal to the inside diameter of the patient's internal nares.

What are the 4 steps of NPA insertion?

Select proper size; lubricate with water-soluble gel and insert into nostril; ensure the flanged end rests against the nose and distal tip rests behind the uvula; secure with tape around the flanged end.

What direction should the bevel face during NPA insertion?

Toward the septum.

What should be done if resistance is encountered during NPA insertion?

Do not force the airway; withdraw it and attempt insertion through the opposite nare.

What airway-opening maneuvers should still be maintained during NPA insertion?

Head-tilt/chin-lift or jaw thrust.