Airway management
Chris Carter in Critical Care Nursing in Resource Limited Environments, 2019
Nurses need to be able to manage a variety of airway emergencies, ranging from attending a ward cardiac arrest and managing an airway, a patient arriving in critical care requiring emergency intubation to managing a tracheostomy in a long-term ventilation patient. This chapter analyses the basic principles of airway management, including airway adjuncts, rapid sequence induction and tracheostomy care. An airway obstruction can be partial or complete. Prior to the arrival of specialist emergency equipment, basic airway opening procedures must be used. Following any airway procedure check the airway remains patent by looking, listening and feeling. If the airway is obstructed, look and remove any solid foreign body in the mouth with forceps or suction. Both nasopharyngeal airway and oropharyngeal airway prevent soft palate obstruction and backward tongue displacement in an unconscious patient, but basic airway opening procedures including a head, tilt chin lift or jaw thrust may be needed.
General anaesthesia and failure to ventilate
Philip Steer, Gwyneth Lewis in Crises in Childbirth Why Mothers Survive, 2018
General anaesthesia deaths relate to airway disasters, such as failure to intubate, oxygenate and ventilate. A pregnant woman is at higher risk of airway management difficulties than normal. This chapter summarises factors that increase the likelihood of airway difficulties at intubation and extubation in pregnant patients. Many detailed airway management algorithms have been published which deal with every potential complication. There is an increase in oxygen consumption of up to 16% at term, compared with non-pregnant controls. A pregnant woman with her increased oxygen requirement and decreased functional residual capacity will desaturate much faster, particularly if she is obese. Appropriate drugs for induction of anaesthesia and muscle relaxation should be available at all times in the obstetric unit. Oxygenation is most likely to be successful if a two-person, four-handed ventilation technique is used with an oropharyngeal airway. A purpose-designed cricothyroidotomy kit or jet ventilation catheter with a jet ventilator can be used to provide a surgical airway.
Paper 1 Questions
James Wigley, Saran Shantikumar, Andrew Paul Monk in Get Through, 2014
An oropharyngeal airway should be sized according to which one of the following descriptions? The measurement between the canines and the angle of the jaw The measurement between the labial commissure and the external auditory meatus The approximate diameter of the patient’s little finger By a combination of the patient’s sex and approximate size (big or small) The measurement between the hyoid and the chin
Evaluations of the tongue and hyoid bone positions and pharyngeal airway dimensions after maxillary protraction treatment
Published in CRANIO®, 2019
Dong-Min Hwang, Ji-Yeon Lee, Yoon Jeong Choi, Chung-Ju Hwang
ObjectiveTo assess changes in the tongue and hyoid bone positions and airway dimensions after maxillary protraction using lateral cephalograms. MethodsLateral cephalograms were obtained before (C0) and after (C1) an observation period for untreated children with skeletal Class I malocclusion and before (T0), immediately after (T1), and one year after (T2) maxillary protraction in children with skeletal Class III malocclusion. Cephalometric measurements were compared between the time points in both patient groups. ResultsImmediately after maxillary protraction, the tongue moved superiorly and the nasopharyngeal and superior oropharyngeal airway dimensions increased. No significant changes in the middle or inferior oropharyngeal airway dimensions or in the hyoid bone position were noted after treatment. ConclusionsMaxillary protraction improved tongue posture and modified the nasopharyngeal and superior oropharyngeal airway dimensions in patients with skeletal Class III malocclusion. Consequently, maxillary protraction may restore the intra- and extraoral balance and improve respiratory function.
Evaluation of the Posterior Airway Space Following Biobloc Therapy: Geometric Morphometrics
Published in CRANIO®, 2007
G. Dave Singh, Ana Victoria Garcia-Motta, William M. Hang
The aim of this study was to evaluate changes in the posterior airway space in patients following Biobloc therapy, using geometric morphometrics. Pre- and post-treatment lateral cephalographs of 53 children (mean age, 12.9±1.5 years; mean treatment time, 21.3±6.2 months) were scanned and 27 landmarks encompassing the airway were digitized. Mean configurations were computed using Procrustes superimposition, followed by principal components analysis (PCA) and finite-element scaling analysis (FESA). Marked shape-changes were identified using PCA for the airway following treatment (p
Compensatory Mechanisms Induced by High Oropharyngeal Airway Resistance in Rats
Published in Acta Oto-Laryngologica, 1991
Livije Kalogjera, Boris Pegan, Vlado Petric
Acid base balance changes were observed during 72 h following bilateral nasal obstruction in rats. Mouth breathing caused acute respiratory acidosis and marked aerophagia, leading to spontaneous death of the experimental animal 80 to 90 h postoperatively. Stenotic oropharyngeal airway, due to palatal-epiglottic approximation, is supposed to be responsible for respiratory insufficiency in the nose obstructed rats. The compensatory changes in respiratory mechanics caused by high oropharyngeal airway resistance, together with some possible reflex changes, may have caused either air swallowing or aspiration. As changes in acid base balance parameters did not show breakdown of the compensatory mechanisms during the first 72 h postoperatively, it is supposed that the increased air volume in stomach and guts, causing elevation of the diaphragm and paralytic ileus, contributed to the experimental animals' death.
Related Knowledge Centers
- Airway
- Emergency Medical Technician
- Tracheal Intubation
- Tongue
- Epiglottis
- First Responder
- Paramedic