Airway management

notes from RespiratoryCram

what is the most common cause of airway obstruction?

loss of muscle tone in unconscious pt which causes base of tongue to obstruct the airway

preferred way to open airway?

head-tilt/chin lift

preferred method to open the airway for motor vehicle accidents/falls?

modified jaw thrust

are oropharyngeal airways for unconscious or conscious pts?

unconscious pts

2 types of oropharyngeal airways?

• berman airways

• guedel airways

oropharyngeal airway indications?

• prevent/treat obstruction caused by base of tongue in unconscious/sedated pt

• protect ett from biting by intubated pts

• facilitate suctioning of the oropharynx

oropharyngeal airway complications?

• do not use in conscious pt

• gagging, vomiting, laryngospasm

how to measure oropharyngeal airway?

measure from angle of jaw to corner of mouth

how to insert oropharyngeal airway?

first inserted upside down until it reaches hard palate, then is rotated 180 degrees as is advanced past tongue

advantages of nasopharyngeal airways?

• tolerated well by conscious pts

• allows pt to speak, eat, drink

nasopharyngeal airway indications?

• pts with ineffective cough requiring suctioning

• conscious pts whose tongue is obstructing airway

• pts requiring pharyngeal airway but don’t have access to mouth

nasopharyngeal airway complications?

• epistaxis

• increased airway resistance

• airway obstruction due to plugging of nasopharyngeal airway w/ secretions

• aspiration of nasopharyngeal airway

nasopharyngeal airway contraindications?

• closed head injury (tbi)

• pts receiving anticoagulant therapy

how to measure length of nasopharyngeal airway?

measure distance from pt’s earlobe to tip of nose

laryngeal mask airway (lma) indications?

• difficult airway/failed intubation

• difficult bag mask/ventilation

• short-term ventilation during surgery

laryngeal mask airway (lma) contraindications?

• do not use if risk aspiration exists

• do not use if personnel are not trained in lma insertion

• pt must be properly anesthetized to avoid gagging/vomiting

lma insertion technique?

• lubricate and fully deflate

• use index finger and blindly guide mask in oropharynx

how much should lma be inflated?

• till no leak is heard

• max of 60 cm H2o

when can lma be removed?

when pt can open mouth on command?

king supraglottic airway description?

• single lumen tube with two cuffs

• distal cuff is inserted into the esophagus and proximal cuff sits above airway

how much are cuffs on king supraglottic airway inflated?

either 60 cm H2o or till no leak is heard

king supraglottic airway indications?

• difficult airway

• lack of trained personnel for ET intubation

king supraglottic airway contraindications?

• conscious pt

• DNR/DNI

which supraglottic tubes are meant to be short term and should be replaced asap?

• king supraglottic airway

• esophageal tracheal combitube (etc)

esophageal tracheal combitube (etc)?

• can provide effective ventilation whether place in esophagus or trachea

• has two lumens, two pilot ballons, and two cuffs

esophageal tracheal combitube (etc) indications?

• difficult airway

• lack of trained personnel in ett intubation

esophageal tracheal combitube (etc) contraindications?

• conscious pt

• DNR/DNI

how to insert esophageal tracheal combitube (etc)?

• blindly inserted without laryngoscope

• ventilate first through longer blue tube and auscultate stomach + lungs

• switch ventilation to shorter white tub if auscultation reveals ventilation of the stomach

how much do you inflate esophageal tracheal combitube (etc) cuffs)?

• large pharyngeal balloon with 100 cc

• small esophageal balloon with 15 cc

what kinda cuffs should be used on tracheal tubes?

high volume/low pressure

what is the point of the radio - opaque line on tracheal tubes?

used for imaging identification of placement

what is the murphy’s eye on ett?

hole near tip of tube that allows ventilation to continue if opening of tube gets obstructed

what is the cass ett tube?

proves continuous subglottic suction just above cuff at -20 Hg

what is the cass ett used for specifically?

vap prevention

double-lumen ett description?

contain two separate lumens each with their own tubes

what is the double-lumen ett used for?

independent lung ventilation

double-lumen ett is aka?

• carlen’s tube

• endobronchial tube

double-lumen ett indications?

• surgical procedures

• lung abscess

tracheostomy tube indications?

• long-term ventilation

• emergency airway because of obstruction

• emergency airway because of trauma

• anatomical airway abnormalities

• osa

• protect against aspiration

tracheostomy tube advantages?

decreased airway resistance

pt can eat with cuff deflated

pt can speak if using speaking device

pt can be connected to vent

tracheostomy tube early complications?

• bleeding

• pneumothorax

• subcutaneous emphysema

tracheostomy tube late complications?

• tracheomalacia

• esophageal tracheal fistula

• hemorrhage

• infection

• obstruction

how much time after trach tube is put in are early vs late complications?

• early = first 24 hrs

• late = more than 2 days

how do you clean non-disposable inner cannulas?

with 50/50 mixture of hydrogen peroxide and water

when should cuff on trach tube be inflated?

• during positive pressure ventilation

• when pt is eating

name of speaking valve for trach?

passy-muir speaking valve

how does passy-muir speaking valve work?

pt inhales through speaking valve and exhaltes through mouth or nose which allows air to pass through vocal cords

what types of trach tubes can passy-muir speaking valves be placed on?

• fenestrated or non-fenestrated tubes

what do you need to do before using a passy-muir speaking valve?

deflate cuff first!!!

fenestrated trach tube description?

has hole near middle of the tube which allows air to pass through upper airway

when should fenestrated trach tubes be used primarily?

for weaning

jackson trach tube description?

metal tube with no cuff

can jackson trach tube be used for positive pressure ventilation?

nope

bvm inlet valve description?

one-way valve that controls air/o2 coming into bag

bvm exhalation valve description?

one-way valve between bag and pt that prevents pt from rebreathing their exhaled air

bvm oxygen reservoir attachment description?

either bag or o2 tubing that is attached to reservoir

bvm pressure relief valve description?

• safety feature

• mostly used with infants/kids

• used to prevent excessive pressures from being delivered

bvm pressure manometer description?

• safety feature

• used with infants

• gives therapist breath-to-breath indication of peak airway pressures being applied to pt

what should flow for bvm be set to?

10-15 L/min

what should first choice be if bvm has issues?

get another bag

what is required when transporting intubated pts and when performing cardioversion?

bvm

what do you do if bvm reservoir bag does not refill between delivered breaths?

increase the flow

what does a leak anywhere in the bvm system typically cause?

• poor chest rise

• lack of resistance when squeezing bag

for acute airway obstruction, what should you do before ventilating?

• look for/remove foreign objects from mouth

for acute airway obstruction, should you do a blind sweep of the pts mouth?

nope!!!