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What are the basic indications for airway management ? (4)
1.To protect the airway (foreighn objects or vomit)
2. To relieve airway obstruction
3. To remove secretions
4. To seal the lower airway for mechanical ventilation
How far do pharyngeal airways extend?
only into the pharynx
What are artificial airways that are placed in the trachea are called ?
What is intubation?
The process of placing an artificial airway into the trachea
When inserting an artificial airway, what manover should you do with the patients head if they have a spinal injury?
What are the 8 types of artificial airways?
- 1. Oropharyngeal
- 2. Nasopharyngeal
- 3. Esophageal Obturator
- 4. Esophageal Gastric Tube
- 5. Combitube
- 6. Laryngeal Mask Airway
- 7. Endotracheal Tubes
- 8. Trach Tubes
Oropharyngeal: Seperates the ____ from the ______.
Patient breathes through the ____ created by the ______.
Tip of the airway rests at the base of the ____, above the ____.
1. tongue, oropharynx (posterior pharyngeal wall)
2. opening created by the airway
3. tongue, epiglottis
Why is the oropharyngeal airway used on the unconcious patients?
Because it would stimulate the pharyngeal gag refelx if they were conscious
How is the oropharyngeal airway measured to fit patients? and what happens if it is too large or too small?
Its measured from the corner of the mouth to the jaw angle
If it is too small the tongue will obstruct the airway
If it is too large it will press on the epiglottis
What are the two types of oropharyngeal airways?
1. Guedel Airway - Single center channel
2. Berman Airway - Two parallel side channels
What is the proper way to insert a oral airway?(4 steps)
1. open mouth with cross finger technique
2. insert airway w/tip pointing up to avoid pushing tongue backwards
3. rotate airway tip slowly (180 degrees) downward until its curve matches the curve of the tongue
4. the flange of the airway should rest against the patients lips
What are the main uses of oropharyngeal airways?
1. Maintain patients airway when the tongue would otherwise obstruct the oropharynx (upper airway)
2. can be used as a bite block for patients with oral tubes
3. required for bag/mask ventilation
4. provides access for oral suction
Nasopharyngeal Airways: Seperates the ____ from the ___ ____.
The tip rests between the base of the ____ and the _____.
Better tolerated by _____ and _____ patients.
1. tongue, soft palate (posterior pharyngeal wall).
2. tongue, oropharynx
3. semiconscious and unconscious patients
1.How often should you alternate a nasopharyngeal airway?
2. How do you measure it to fit a patient? what happens if its too long?
3. Should the diameter be small or large?
4. Should it be used on children or infants?
1. Every 24 hours to prevent complications
2. Size it from the tip of the nose to the ear lobe or jaw. Too long = coughing and gagging
3. Insert largest diameter that can be passed with minimal trauma.
4. Generally try not to because their nasal passageway is very small
What are nasopharyngeal airways do? (2)
What can the proximal end do to a patient?
Why does a nasopharyngeal airway need to be closely inspected?
1. maintains patient airway, and facilitates frequent nasal suctioning
2. proximal end may cause pressure necrosis
3. close inspection required to prevent tube from slipping out of position
The Pharynx is used as a common pathway for what two things?
food and air
What are nasopharyngeal airways normally made with?
rubber or plastic polymers
Esophageal Obturator airway: Temporary emergency device that is a combination of a ____ and a ____.
Used by individuals inexperienced in ____ ____.
Designed to intubate the _____ so that it is blocked off by the ____ ____.
1. mask & airway
2. tracheal intubation
3. esophagus, by the blunt tip
Once the esophageal obturator is positioned what are the next 3 steps? and what can happen if the tube is accidentally inserted in the trachea?
1. cuff is inflated, mask is sealed, and ventilation is achieved through holes located in the laryngeal area
2. if tube goes into the trach it only takes 5 min for patient to go brain dead due to lack of oxygen. Can be fatal.
How many ml of air should be in the cuff on the Esophageal Obturator Airway?
What must happen before it can be removed?
1. No more than 30-35ml of air
2. Trachea must be intubated and protected by inflated cuff before EOA can be removed
What are the indications (1) and complications (3) of using a Esophageal Obturator Airway?
1. Indicated for use in unconsious patients 16 years of age or older
2. Complications: esopageal rupture, misplacement of tube in trach, and vomiting and aspiration upon removal
Esophageal Gastric Tube Airway: Similar design and function to the ____.
What is the difference?
Explain the mask?
2. The long cuffed tube has a gastric tube that can be passed into the stomach
3. The mask has two ports, one goes to the long cuffed gastric tube abd the other port is used for mask ventilation
Double-Lumen Airway: aka ______.
Inserted _____ through the _____, and into the _____ or the _____.
Name the four parts on it?
What do both of the cuffs seal?
2. Blindly, oropharynx, into the trachea or the esophagus
3. It has two external openings, two 15-mm adapters, two lumens, and two cuffs.
4. One cuff seals the oropharynx and the second one seals the trachea or esophagus.
The Combitube is a double lumen with features of what two other types of artificial airways? and what is it used for?
1. EOA & ET
2. For emergency intubation w/o a laryngoscope
Once the double lumen is inserted what happens ?
The large cuff in the oropharynx AND the second cuff at the distal end of the long tube will be inflated.
(large cuff prevents air from going up)
Combitube: Rescuer should ventilate patient through which ever tube results in chest expansion.
What happens if the long tube is placed in the esophagus? or trachea?
Esophagus: The tube will perform like a EGTA and ventilate through the proximal tube
Trachea: The tube will perform like a ET tube and ventilate through the distal tube
What is another version of the Combitube? ...explain it ?
It has a single channel to inflate both ballons. It also has an additional anterior opening just below the proximal cuff to allow an airway exchanger catheter to be inserted for exchange to the endotracheal tube.