Chap 08 - Airway Management

Airway

the passageway air enters into/exits the body - includes the nose, mouth, pharnyx, larynx, trachea, bronchi, and lungs (p.173)

Bronchoconstriction

the contraction of smooth muscle that lines the bronchial passages - results in decreased internal diameter of the airway/increased resistance to air flow (p.177)

Gag Reflex

vomiting or retching that results when something is placed in the back of the pharynx (p.184)

Head-tilt, Chin-lift Maneuver

a means of correcting blockage of the airway caused by the toungue - done by tilting the head back/lifting chin (p.181)

Jaw-thrust Maneuver

a means by correcting blockage of the airway by moving the jaw forward without tilting the head/neck (p.182)

Nasopharyngeal Airway

a flexible breathing tube inserted through the patient's nose into pharynx to help maintain an open airway (p.183)

Oropharyngeal Airway

a curved device inserted through the patient's mouth into the pharynx to help maintain an open airway (p.183)

Patent Airway

airway (from nose/mouth to lungs) that is open and clear and will remain that way without interference (p.174)

Stridor

high-pitched sound generated from partially obstructed air flow in the upper airway (p.177)

Suctioning

use of a vacuum device to remove blood, vomitus, and other secretions/foreign materials from the airway (p.188)

What maneuver is used to clear a blocked airway by the toungue when no trauma, or injury is suspected?

head-tilt, chin lift maneuver

What is the most commonly used method for opening an obsturcted airway of an unconscience patient with suspected head, neck, or spine injury (or unknown mechanism)?

jaw-thrust maneuver

Nasal Airway (NPA)

nasopharyngeal airway

Oral Airway (OPA)

oropharyngeal airway

What are the ABCs?

airway, breathing, and circulation: the means by which oxygen is brought into the body and transported to cells

What is required for a patent airway?

control of the muscles that form the airway (muscle tone)

What airway is distal to the mouth & nose?

pharynx

What three regions is the pharynx comprised of?

nasopharynx, oropharynx, laryngopharynx

Glottic Opening

entry point into the larynx

Epiglottis

large leaf-like structure that protects the glottic opening

Trachea

air enters this tube from the glottic opening and is protected by 16 rings of cartilage, preventing it from collasping

Carina

the branch/fork in the lower airway where the bronchi split

Bronchi

the two branches of the lower airway that branch off the trachea at the carina

Bronchioles

the smaller branches off the bronchi

Alveoli

small sacs within the lungs where gas exchange takes place (diffusion)

What factors can lead to collapse of the airway?

altered mental state and neurological disorders which lead to a loss of muscle tone

Where does the lower airway begin?

below the larynx
(includes the trachea, bronchial passages, and alveoli)

Muscle Tone (intact)

control of the muscles that form the airway

What is a common obstruction in a person with a decreased mental status?

the tongue (more precisely, the epiglottis connected to the tongue)

What is an example of an acutely obstructed airway?

choking on a foreign body

What is an example of a chronically (over time) obstructed airway?

burns, blunt force trauma, infections (swelling of the tissue around the glottic opening)

What is an airway obstruction common in diseases like asthma?

bronchoconstruction (bronchospasm)

Where is an obstruction located if the patient is exhibiting stridor?

upper airway

Where is an airway obstruction located if the patient is using the "sniffing position"?

upper airway

If a patient is awake, but snoring, what is this an indication of?

loss of control of the tongue

What are the signs of an inadequate airway?

no signs of breathing
evidence of foreign bodies (blood, vomit, broken teeth, etc.)
patient cannot speak
patient has a hoarse/raspy voice
noises such as wheezinig, crowing, stridor, snoring, gurgling, or gasping are heard
retractions or nasal flaring in c

What position should a person with diminished mental state and signs of an inadequate airway be placed in?

supine

Which technique should be used if the patient has a suspected head/neck injury?

jaw-thrust maneuver

OPA

oropharyngeal airway (oral airway)

NPA

nasopharyngeal airway (nasal airway)

Airway Adjuncts

devices that aid in maintaining an open airway

What airway adjunct should be used for patients who exhibit gag reflex?

nasopharyngeal airway (NPA)

What must be maintained once an airway adjunct is in place?

head-tilt, chin-lift, or jawlthrust maneuver

How do you determine the appropriate size oral airway to use on a patient?

measure the device from the corner of the patient's mouth to the tip of the earlobe on the same side of the patient's face

For placement of a oropharyngeal airway in a child patient, what two things must the EMT do while inserting the device that is different from the method used on an adult?

use a tongue depressor
do not rotate up

How do you determine the appropriate size nasal airway device to use on a patient?

measure the device from the nostril to the tip of the earlobe or to the angle of the jaw

What must be done prior to inserting the NPA into a patient's nasal airway?

lubricate the outside of the tube with a water-based lubricant

If a patient has clear (cerebrospinal) fluid coming from the nose or ears, what is this an indication of?

a skull fracture where the airway would pass

What is the minimum suction mounted and portable sunction systems must be able to provide?

30 liters per minute, 300 mmHg

What type of tubing must be used on a mounted/portable suction unit?

thick-walled, nonkinking, wide-bore tubing

What is the most popular type of suction tip?

pharyngeal tip (Yankauer, tonsil sucker, tonsil-tip)

What is the first rule in appropriate infection control when suctioning?

use of protective eyewear, masks, and disposable gloves

Sunction Catheters

flexible plastic tubes classified in size by a number "French"
(14 French, 8 French, etc.)

What is used to clear matter that is partially blocking suction tubing?

clean (perferably sterile) water

What is the second rule of suctioning to prevent hypoxia and, potentially, death?

limit suctioning to no longer than 10 seconds at a time

For the third rule of suctioning, why do you place the tip or catheter where you want to begin the sunctioning and suction on the way out?

most suction tips and catheters do not produce suction at all times - you have to start suctioning

Why must we be extra careful with the airway of patients who have facial injuries?

the blood supply to the face is rich and blunt/penetrating injuries to the face frequently result in severe swelling

What is the best way to remove obstructions?

manually

What should be done with a patient's dental appliance in an emergency?

left in place if possible

What are three important airway management considerations for pediatric patients?

open the airway gently
do not hyperextent the neck
oral or nasal airway may be needed
use a rigid grip for suctioning (careful not to touch the back of the airway)

Hypoxemia

an abnormally low concentration of oxygen in the blood

Bronchodilator

drug that relaxes the smooth muscles of the bronchi & bronchioles, reversing bronchoconstriction

Where will there be diminished airflow if a patient is suffering from profound bronchoconstriction?

distal alveoli

hypercapnia/hypercarbia

when a patient is breathing inadequately and there are elevated levels of carbon dioxide in the blood

Apnea

the absence of breathing or reparatory arrest

Dyspnea

shortness of breath/difficulty breathing

What is required for proper body substance isolation (BSI) during airway management & ventilation procedures?

gloves, mask, and goggles

How should the bevel of an NPA be turned when inserting the nasopharyngeal airway?

bevel should be turned toward the nasal septum

You are ventilating a cardiac arrest patient when he begins to vomit copious amounts of large pieces of undigested food. What would be the most effective way to clear the airway?

use a large bore suction tubing without a tip or catheter attached

What should be kept in mind when assessing and managing the airway of a pediatric patient?

their trachea is easily obstructed by swelling