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!
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You cannot do head tilt chin lift when pt has: | Cervical spine injury
Must do jaw thrust maneuver |
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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
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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
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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
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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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