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Airway Care Cornell Notes

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Upper Airway or Glottic Obstruction

  • Most Common issues is Soft Tissue of upper airway due to decrease LOC
  • Loss of Muscle Tone -  – Usually evidence of decrease   LOC
  • Swelling –Common Allergic reaction
    Glottic vs Sub-glottic
  • First Thing
    - While walking in the room..
    - Look at pt take in their color, WOB Is there any rise & fall of the chest?
    First thing you do is open airway 
    -Do head tilt chin and lift open airway If they don’t have any do not have any respiratory effort
    begin bag mask ventilation

 Common Situations
Working in E.R taking high amount of pain med

-Over Dose
-Extreme alcohol intoxication

-Basic to remember when soft tissue damage go back to CPR
-airway, breathing and circulation

Symptoms of upper airway obstruction or glottis obstruction
-Increase WOB
-Retractions & Accessory
-Muscle Use
-B/S Diminished or absent flow


Treatment: Open of the airway


Do head chin and lift to open airway quickly asses do you have adequate depth of respirations?

Often in pts in overdose won’t have adequate respirations!
 

You cannot do head tilt chin lift when pt has:

Cervical spine injury
Must do jaw thrust maneuver

Foreign Substances

Mostly in pediatric pts

Especially in decrease LOC

-Increase likely hood of obstruction or aspiration

do hemlock maneuver
TRY TO GET OUT OF AIRWAY

Use of FORCEPTS

Treatment



Neck Extension & Chin Manipulation

1st TX of choice

Side Lying Enhances Removal of Foreign Body

Oropharyngeal Airway

OPA

  • Helps ensure Patency Between Tongue and Pharynx
  • COMOTOSE PATIENTS ONLY
  • Also used as bite block in comatose intubated patients

Corner of mandible to corner of mouth to find correct fit!


J-Shaped Hook
-Pull pts tongue forward position so that the pts airway remains open

OPA
NPA: Soft, longer intended to go through the Nair

Doesn’t guarantee ventilation or breath  

Nasopharyngeal Airway

NPA

  • Better tolerated in the semicomatose patient
  • Used also to facilitate nasotracheal suction
  • Safety pin and tape will prevent aspiration (because if pt has a high WOB) can inhale really hard then it can  obstruct their airway

Example: Pts coming from O.R to pacu

To measure: Know if you have right size
-From tragus of the ear all the way around to the nose

Put the flange (top part) to the pts nose

 

What are the indications for Artificial Airway?

  • Relief of Airway Obstruction
  • Protection of Airways primary reason we do this

Reflexes Obtunded (lose) from Top down

Pharyngeal – Laryngeal-Tracheal- Carinal reflexes

  • Facilitate Suctioning
  • Support Ventilation








Lose LOC

Increase risk of colonization of the mouth not be able to sustain ventilation
Suction thru e.t tube

One of the most common reason to put in airway is for Ventilation, or protect airway

All protect airway, none guarantee ventilation!
Have to reassess!

Hazards of Artificial Airways

Mostly endotracheal tube

  • Bypasses normal defense mechanisms       Colonization
  • Removes cough effectiveness
  • Removes vocal communication
  • Loss of personal dignity
  • Increase RAW if too small of tube
  • Damage to Airway
  • Any bacteria in mouth or in ventilator can colonize and grow so can Increase risk of pneumonia
  • If pt can’t cough Increase risk of atelectasis and retained secretion
  • If increase RAW in turn will  Increase WOB
  • If tube is too large cause damage to vocal cords
  • Jamming it in can cause damage to mucus layer, bleeding and or swelling


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