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Airway Management Part I

Airway Management Part I. RET 2275 Respiratory Care Theory 2. Manual Resuscitators. Manual resuscitator Portable, hand-held device that allows for the delivery of positive pressure and supplemental oxygen to the airway AKA: resuscitator bag, Ambu bag, bag-valve-mask (BMV) Generic parts:

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Airway Management Part I

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  1. Airway ManagementPart I RET 2275 Respiratory Care Theory 2

  2. Manual Resuscitators • Manual resuscitator • Portable, hand-held device that allows for the delivery of positive pressure and supplemental oxygen to the airway • AKA: resuscitator bag, Ambu bag, bag-valve-mask (BMV) • Generic parts: • Self-inflating bag • Air intake valve • Nonrebreathing valve • Exhalation valve • Oxygen reservoir

  3. Nonrebreathing Valve Types Spring-loaded ball Manual Resuscitators

  4. Nonrebreathing Valve Types Duckbill Manual Resuscitators

  5. Nonrebreathing Valve Types Leaf Manual Resuscitators

  6. O2 Powered Resuscitators Pressure limited devices that work similarly to reducing valves Demand valve that can be manually operated or patient triggered Can deliver 100% O2 at flows <40 L/min Inspiratory pressures are limited to 60 cm H2O Manual Resuscitators

  7. Ambu SPUR

  8. Manual Resuscitators • Device/Patient interface • Mask

  9. Manual Resuscitators • Device/Patient interface • Directly connected to endotracheal tube

  10. Manual Resuscitators • Uses • Ventilation during a resuscitation effort • Transport of a ventilator-dependant patient • Hyperinflation and delivery of enriched oxygen mixtures before and after a suctioning procedure • To generate airway pressures and large tidal volume to expand atelectatic lung segments • Adjunct in directed coughing

  11. Upper Airway Obstruction • Causes of Upper Airway Obstruction • Soft tissue obstruction • Loss of muscle tone resulting in the tongue falling back against the soft palate • CNS depression – drug overdose, anesthesia • Cardiac arrest • Loss of consciousness

  12. Upper Airway Obstruction • Causes • Laryngeal obstruction more commonly the result of: • Muscle spasm (laryngospasm) • Edema • Croup • Epiglottitis • Foreign material • Aspirate • Vomitus • Blood • Space-occupying lesions, e.g., tumors

  13. Upper Airway Obstruction • Causes • Laryngeal obstruction more commonly the result of: • Muscle spasm (laryngospasm) • Edema • Croup • Epiglottitis • Foreign material • Aspirate • Vomitus • Blood • Space-occupying lesions, e.g., tumors

  14. Upper Airway Obstruction • Clinical Findings • Noisy inspiratory efforts, e.g., snoring • Silence – complete obstruction • Retractions • Intercostal • Sternal • Clavicular

  15. Upper Airway Obstruction • Clinical Findings • Prolonged, partial upper airway obstruction • Hypoxemia and hypercapnia • Total airway obstruction • Death in 5 – 10 minutes

  16. Upper Airway Obstruction • Positional Maneuvers to Open the Airway • Head Tilt • Tilting the head back to relieve soft tissue obstruction

  17. Upper Airway Obstruction • Positional Maneuvers to Open the Airway • Anterior Mandibular Displacement (jaw thrust) • Grasping the jaw at the ramus on each side and lifting the jaw forward • Treatment of choice for suspected vertebral column trauma

  18. Manual Resuscitators • Ventilatory assistance may be administered with a manual resuscitator

  19. Standards Have standard 15:20 mm (ID:OD) adaptors Deliver > 85% oxygen at 15 L/min. Volume of bag Adult: 1600 ml Child: 500 ml Infant: 240 ml Allow for delivery of PEEP Manual Resuscitators

  20. Standards Allow for attachment of volume and pressure monitoring devices Child resuscitators should be pressure limited at 40 (± 10 cm H2O) Infant resuscitators should be pressure limit at 40 (± 5 cm H2O) No pressure limiting system for adult resuscitators Manual Resuscitators

  21. Gastric distention Aspiration Diminished cardiac output May be avoided by ventilating the patient using an inspiratory to expiratory (I:E) ration of 1:2, which allows the heart to fill during the expiratory phase when there is no pressure in the thoracic cavity Hazards of Manual Resuscitation

  22. Pharyngeal Airways Specialized devices employed to maintain a patent airway Airways in Manual Resuscitation

  23. Oropharyngeal Airways

  24. Oropharyngeal Airways • Function • Restores airway patency by separating the tongue from the posterior wall of the pharynx • Insertion • Orally • Use jaw lift or tongue displacement • Correct sizing • Measure from the corner of the patient’s mouth to angle of the jaw • Incorrect placement can worsen obstruction! • Used in comatose patients

  25. Oropharyngeal Airways • Correct Sizing

  26. Oropharyngeal Airways • Correct Sizing

  27. Oropharyngeal Airways • Insertion • Using a head-tilt-chin-lift, a modified jaw-thrust, or by grasping the tongue and jaw by placing your thumb in the patient's mouth, move the tongue forward. Position the OPA as shown with the tip in the patient's mouth and slowly insert the OPA. As the OPA is being inserted, slight resistance will be felt.

  28. Oropharyngeal Airways • Insertion • At the point resistance is met, insertion should continue while simultaneously rotating the OPA 180°. Advance the OPA until the flange is resting on or just above the patient's teeth.

  29. Nasopharyngeal Airways

  30. Nasopharyngeal Airways • Function • Restores airway patency by separating the tongue from the posterior wall of the pharynx • Used when oral placement is not possible • Insertion • Nasally • Necessary to check placement • Correct sizing • Measure from the patient’s earlobe to the tip of the nose • Incorrect placement can worsen obstruction! • Used in awake patients

  31. Nasopharyngeal Airways • Correct Sizing of NPA

  32. Nasopharyngeal Airways • Correct Sizing of NPA

  33. Nasopharyngeal Airways • Insertion of NPA • First check the nostril for signs of fracture or obstruction then apply generous amounts of a water-based lubricant to the NPA taking care not to fill the tip with the lubricant • Orient the bevel end so that it will pass along the inside of the nasal cavity with minimal effort

  34. Nasopharyngeal Airways • Insertion of NPA • Insert the NPA until the flange (the large end of the tube) is seated on the patient's nose

  35. Nasopharyngeal Airways • Proper placement of the nasopharyngeal airway

  36. Ventilation with Manual Resuscitator

  37. Ventilation with Manual Resuscitator • Place the patient supine • Open the airway – manual maneuver • Insert pharyngeal airway • Place the mask on the patient’s face • Bridge of the nose first • Securing a tight seal below the lower lip • Maintain the mask position with thumb and index finger of one hand, use the third, forth and fifth fingers to hook under the mandible, displacing it anteriorly to maintain a patent airway

  38. Ventilation with Manual Resuscitator

  39. Ventilation with Manual Resuscitator • Two-man ventilation with manual resuscitator

  40. Ventilation with Manual Resuscitator • Ventilate the patient at a rate of 8 – 16 breaths/min. • Watch for chest expansion to ensure adequate volume • I:E ration of 1:2 or better • If the patient has spontaneous respiratory efforts, match your ventilation efforts with the patient’s efforts

  41. Endotracheal Tubes • Function • Relieve airway obstruction • Facilitate secretion removal • Protect against aspiration • Provide positive pressure ventilation • Insertion Site • Nasally • Orally • Placement • In the trachea • 3 – 5 cm above the carina

  42. Endotracheal Tubes • Placement of the ET Tube

  43. Endotracheal Tubes Standard adapter with a 15 mm external diameter Radiopaque Strip (visible on x-ray) Pilot tube Body Pilot balloon Cuff Beveled distal tip

  44. Endotracheal Tubes Length makings (distance in cm from beveled tube tip) “Z-79” or “IT” (Tissue toxicity testing) Inner diameter

  45. Endotracheal Tubes • Murphy’s eye • Provides an alternate pathway for gas to flow in the event the distal tip become obstructed Beveled distal tip

  46. Endotracheal Tubes • Reinforced Wire-Wrapped ET Tube • Helical reinforcing wire imbedded into the PVC material helps prevent kinking when used in a tortuous airway

  47. Hi-Lo EVAC Endotracheal Tube

  48. Indwelling Hi-Lo EVAC Tube

  49. Double Lumen ET Tube • Function • Independent lung ventilation • Unilateral lung disease • Properties • 2 proximal 15 mm ventilator connections • 2 inner lumens for gas flow • 2 cuffs • Larger cuff seal trachea • Smaller cuff seals bronchial lumen • 2 distal openings • Fiberoptic bronchoscopy needed to verify placement

  50. Double Lumen ET Tube • Proper placement

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