EMT Ch 38 Advanced airway Management

nasopharynx
the area directly posterior to the nose
oropharynx
ther area directly above the openings of both the trachea and the esopagus
trachea
the windpipe, the structure that connects the pharynx to the lungs
esophagus
the tube that leads from the pharynx to the stomach
epiglottis
the leaf shaped structure that prevents food and foreign matter from entering the trachea
vallecula
a groove like structure anterior to the epiglottis
larynx
the voice box
vocal cords
two thin folds of tissue within the larynx that bibrate as air passes between them producing sounds
cricoid cartilage
the ring shaped structure that circles the trachea at the lower edge of the larynx
mainstem bronchi
the two large sets of branches that come off the trachea ans enter the lungs. There are right and left mainstem bronchi. The singular is bronchus
carina
the fork at the lower end of the trachea where the two mainstem bronchi branch
bronchioles
smaller branches of the bronchi.
alveoli
the microscopic sacs of the lungs where gas exchange with the bloodstream takes place.
right bronchi
because of haveing less of a curve, things tend to get lodged in the right bronchi. The left has a much sharper curve.
Normal breathing rates
12-20 adults per minute
15-30 children
25-50 infants
Tidal volume
depth
respiratory distress
rate-too fast or too slow
rhythm-irregular pattern
quality-sounds diminished, unequal or inadequate
effort, increased-accessory muscles-unable
to speak full sentences
depth-shallow
cyanosis-blue lips, nailbeds, and fingertips (kids)
cool and clammy skin-
agonal breathing-gasping just prior to respiratory arrest
agonal
gasping just before respiratory arrest
different signs and symptoms for infants and children with inadequate breathing
slower than normal heart rate
weak or absent periphera pulses
retractions between and below the ribs, above the clavicles and at the sternal notch
Nasal flaring
Seesaw breathing
oropharyngeal suctioning
keeping the airway open and free of obstructions. Keep equipment within reach. Use a RIGID TIP
orotracheal intubation
into trachea
endotracheal tube
a tube designed to be inserted into the trachea,
Oxygen
Medication or a
Suction catheter can be directed into the trachea through an endotracheal tube
intubation
insertion of a tube
orotracheal intubation
placement of an endotracheal tube through the mouth and into the trachea
laryngoscope
an illuminating instrument that is inserted into the pharymx to permit visualization of the pharynx and larynx.
advantages of using and ortracheal tube of an apneic (non breathing) patient
complete control of the airway
minimizes the risk of asperation (the tube blocks vomit or foreign matter from being aspirated or breathed into the lungs)
Allows for better oxygen delivery, directly to the lungs
Allows for deeper suctioning of the airway, a flexible endotracheal tube can be passed through the endotracheal tube to suction the trachea to the LEVEL OF THE CARINA.
Complications of orotracheal intubation is
Stimulating of the airway can cause SLOWING of the heart rate
bradycardia.
Hypoxia-inadequate oxygenation or oxygen starvation.
Vomiting
Right mainstem intubation-tube should remain superior to
the right and left mainstem bronchi
Esophageal intubation-prevents ventilation of the lungs, death
Accidental extubation-tube becomes dislodged when moved
hypoxia
inadequate oxygenation or oxygen starvation.
orotracheal intubation equipment
BSI, laryngoscope (Mack and Miller) used in left hand,
Mack and Miller laryngoscopes
straight or curved, sized 0-4, most adults use size 2 or 3 straight or 3 curved.
Mac
Curved-lifts the VALLECULA
Miller
Flat, straight blade fits under the tip of the EPIGLOTTIS
glottic opening
the opening to the trachea
Endotracheal tube
single lumen tube for air and oxygen delivery. 15 mm adapter for connection to the bag valve unit. The distal end has a cuff that inflates and a 10 cc syringe to inflate, and has a pilot balloon that fills when the cuff is inflated. If it does not, assume it has failed and remove. For children less than 8, it may or may not have a cuff. The Murpheys eye is the end opening to lessen the chance of obstruction.
2.0 mm smallest
10.0 mm very large adults
Rule of Thumb, standard size is 7.5
general sizing men, 8.0 – 8.5
women, 7.0 – 8.0
Standard length of 33 centimeters
22 – centimeter mark at the teeth
Inserted to the suprasternal notch, not into either bronchus
accessories to the endotracheal tube
Stylet, a long thin flexible metal probe, shapes into Hockey stick.
stylet
a long thin flexible metal probe, shapes into Hockey stick
indications for using orotracheal intubation
Apneic, not breathing
NO gag reflex or cough
Unresponsive to ANY stimuli
Cardiac Arrest
steps to insertion of orotracheal intubation
Ventilate the patient
Assemble, prepare, and test ALL equipment
Position the patient’s head, if trauma, neutral position.
Prepare to insert the laryngoscope blade
Lift the tongue out of the way
Insert the blade. Curved to the Vallecula
Straight to the Epiglottis
Bring Glottic opening into view
Second rescuer may perform cricoid pressure during
intubation to suppress vomiting and aid
visualization.
Visualize the glottic opening
Insert endotracheal tube with stylet
Remove laryngoscope and stylet.
Inflate the cuff with 5 to 10 cc of air.
Attach a bag valve unit or other ventilation device to the tube.
Confirm Placement
Confirm placement of the tube
Ventilate
Observe rise and fall of chest
Auscultate epicastium for absence of breath sounds
Auscultate over both lungs for breath sounds, equal
Observe for signs of deterioration, cyanosis
Use Medical Direction to confirm correct placement,
pulse oximeter or end-tidal CO2 detector
Correct incorrect placement
Deflate cuff, withdraw the tube and ventilate for 1 min. before another attempt. If breath sounds are heard but not equal, deflate cuff and back it up until sounds are equal.
Correct placement then tape in place, check each time patient is moved.
You can only make 2 attempts.
cricoid pressure
pressure applied to the cricoid cartilage to suppress vomiting and bring the coval cords into view. Adam’s Apple
esophageal detector device EDD
disposable device uses a bulb or syringe to attemt to withdraw air from an endotracheal tube to determine correct placement in the trachea.
Capnometry
the measurement of exhaled carbon dioxide. A graphic recording or display of capnometric measurement .
Broselow tape
can be used to estimate the tube size based on the height of a pediatric patient.
A formula for size
(age + 16) devided by 4 = tube size
less accurate for tube size
diameter of little finger or nasal opening
memorize
infants 3.0 – 3.5 tube
and older infants to 1 year 4.0 tube
uncuffed tube for
8 years old or less
nasogastric intubation of an infant or child
NOSE to the stomack to relieve distention of the stomach
Sizes
newborn 8.0 French
toddler 10.0 French
School age 12.0 French
adolescent 14.0 – 16.0 French
also need 20 cc syringe
water soluble lubricant
emesis basin – vomit
tape
stethoscope
suction unit with connecting tube
measureing a nasogastric tube
tip of nose, around ear, to below the ziphoid process.
emesis
vomit
orotracheal suctioning
deep suctioning, soft catheter to the level of the carina
preoxygenate
check equipment
insert catheter to desired location no further than carina,
no suction
apply suction and withdraw the catheter with a twistin motion
DO NOT EXCEED 15 SECONDS to prevent hypoxia
measuring for suction
lips, behind ear to nipple line
esophageal tracheal combitube
two tubes joined together. Inserted into the esophagus NOT the trachea. Unconscious over 5 ft tall. Smaller size SA 4 and 5 1/2 ft. but not under 16 year old.
larger cuff= 100 cc
small cuff = 15 cc of air
small cuff block off stomach so air exits the tiny holes and goes into the trachea.
Laryngeal Mask Airway LMA
an airway that rests above the glottis, small oval mask with an inflatable cuff. Does not protect from vomit
automatic transport ventilator
ATV used in Europe and gaining popularity
standards
must deliver 100 percent oxygen
default rates of ventilation of 10 pm adults and 20 per min for children
lightweight and rugged
audible alarm to alert the user to problems in ventilation
have a standar 15/22 mm coupling to connect with a mask or endotracheal tube.
NOT suitable for children less than 5 years old.
King LT airway
supraglottic airway, compact device that have controls that set both the rate of ventilation and the tidal volume which are determined by the patients weight.