Airway

Question 1

upper airway

Answer 1

• warms and moistens
• everything above trachea
• nasal passage
• turbinates
• oral cavity
• epiglottis
• vocal cord
• esophagus

Question 2

anatomy of the glottis

Answer 2

• posterior tongue
• epiglottis
• vocal cords
• > true vocal cords
• > false vocal cords
• esophagus
• when tubing you want the tube to enter through glottis and into trachea

Question 3

pediatric airway considerations

Answer 3

• larger head and tongue
• greater potential for airway obstruction
• special attention to proper positioning
• epiglottis is proportionally larger and floppier than adult
• trachea is short and conical shape
• trachea has greater potential for main bronchus intubation

Question 4

airway assessment

Answer 4

• if the trauma patient is talking normally, the airway is open
• further assessment is still required
• assessment of the airway requires the provider to:
• look
• listen
• feel

Question 5

look

Answer 5

• look for findings that may indicate airway obstruction or injury or may lead to pulmonary aspiration
• examples may include:
• blood and secretions
• fractured teeth
• foreign bodies
• vomitus
• hematomas/contusions (tongue, neck)
• gross subcutaneous emphysema

Question 6

listen

Answer 6

• listen for abnormal sounds indicating airway compromise
• examples include:
• snoring
• stridor (inspiratory)
• gurgling (expiratory)
• hoarseness- upper

Question 7

feel

Answer 7

• feel for abnormal masses and signs of airway injury
• examples include:
• hematomas
• subcutaneous emphysema in the neck
• measure oxygen saturation

Question 8

causes of airway obstruction: tongue

Answer 8

• tongue
• most common cause
• falls back, obstructing the airway with decreased mental status
• snoring- clinical finding

Question 9

causes of airway obstruction

Answer 9

• tongue
• foreign body
• blood
• vomit
• teeth

Question 10

blunt injuries

Answer 10

examples of findings may include:

• swelling and edema
• fractured larynx
• subcutaneous emphysema
• hematoma

Question 11

penetrating injuries

Answer 11

• examples of findings may include:
• bleeding into the airway
• subcutaneous emphysema
• hematoma

Question 12

examples of causes of inhalation injury

Answer 12

• dry
• steam
• chemical

Question 13

signs and symptoms of airway burns

Answer 13

• swelling/edema

- stridor

Question 14

airway and spine stabilization

Answer 14

• maintain cervical spine stabilization as indicated by mechanism of injury
• especially important when assessing and performing airway maneuvers
• stabilize spine before airway

Question 15

goal of managing patients airway

Answer 15

-maintain a patent airway that allows for adequate breathing, ventilation, and oxygenation
-management progresses from essential to complex procedures and adjuncts
-Providers should be knowledgeable and skilled in multiple methods of ensuring a
patent airway

Question 16

airway management skills

Answer 16

• essential skills and interventions are applied FIRST- manual airway opening/OPA (NPA)
• complex skills and interventions are performed ONLY if needed
• the choice of technique to manage the airway depends upon:
• knowledge and skills of provider
• situation at the scene
• severity of the patient
• resources available

Question 17

manual management

Answer 17

• trauma jaw thrust

- chin lift

Question 18

simple management

Answer 18

• oropharyngeal airway (OPA)
• nasopharyngeal airway (NPA)
• adjuncts

Question 19

complex

Answer 19

• supraglottic airways- just outside the trachea to seal it off and prevent fluids from getting in
• endotracheal intubation
• rapid sequence intubation (RSI)
• percutaneous airway- needle through cricothyroid membrane
• surgical airway

Question 20

jaw thrust or chin lift

Answer 20

• ALWAYS the first airway maneuvers for the trauma patient
• performed while maintaining manual cervical stabilization
• both techniques lift the mandible, elevating the tongue away from the posterior, opening the airway
• can be used for conscious or unconscious patients

Question 21

OPA and NPA

Answer 21

• both airway adjuncts mechanically elevate the tongue off the poster pharynx to maintain an open airway
• both airways require measurement (length) and sizing (diameter) prior to insertion
• improperly sized or improperly inserted airways can cause obstruction by pushing the tongue against the posterior pharynx
• OPA insertion requires an absent gag reflex
• insertion technique is based on age of patient
• NPA insertion requires the use of a water soluble lubricant

Question 22

supraglottic airways

Answer 22

• bind insertion technique
• less complex technique than endotracheal intubation
• less initial training
• easier to maintain proficiency
• requires an absent gag reflex
• occlude the pharynx to limit regurgitation but do not prevent aspiration
• some supraglottic airways are available in pediatric sizes
• ex. laryngeal mask airway (LMA), combitube, and king LT airway

Question 23

endotracheal intubation

Answer 23

• complex technique
• requires:
• significant initial training
• multiple pieces of equipment
• substantial ongoing training to maintain proficiency
• placement options: oral and nasal
• oral- pharmacologically assisted intubation, rapid sequence intubation (RSI), nonpharmacologic

Question 24

endotracheal intubation: assess need for intubation based on:

Answer 24

• inability to maintain a patent airway
• decreased LOC
• upper airway burns
• signs of impending airway obstruction
• endotracheal intubation may also be considered when alternate methods of airway management are deemed inadequate or inappropriate based on the situation and severity of injuries

Question 25

endotracheal intubation: before attempting intubation:

Answer 25

- anticipate potential difficulties - trauma related - disrupted/displaced anatomy - pre-existing conditions - small mouth/mandible - short neck - obesity - prepare an alternate plan for airway management in the event of unsuccessful endotracheal tube placement - have all necessary equipment immediately at hand

Question 26

endotracheal intubation: important considerations

Answer 26

- essential airway skills are often sufficient to provide a patent airway - if intubation is required: - preoxygenate to maximize oxygen saturation - reoxygenation patient in between intubation attempts - monitor oxygen saturation (pulse oximetry) - throughout the procedure - follow intubation, verify proper tube placement

Question 27

surgical airways: complex techniques

Answer 27

- requires: - significant initial training - multiple pieces of equipment - substantial ongoing training to maintain proficiency

Question 28

surgical airways considerations

Answer 28

- has potential for : - multiple complications - damage to nearby anatomic structures

Question 29

surgical airways: population

Answer 29

may be considered for: - massive facial trauma that prevents endotracheal intubation - upper airway obstruction unrelieved by other techniques - failed intubation and alternative airway methods are unavailable or unsuccessful

Question 30

confirmation of tube placement

Answer 30

-constant end-tidal carbon dioxide monitoring physiological: - breath sounds - chest rise - change in skin color - pulse rate - continually monitored and reassessed mechanical: - end tidal CO2 - colorimetric - outdated - capnometry - wave form capnography - pulse oximetry

Question 31

summary

Answer 31

- goal is to secure and maintain a patent airway - assess airway by looking, listening, and feeling - maintain manual stabilization of the head and spin as indicated - apply essential airway maneuvers first - utilize complex airway techniques only when required - anticipate difficulties and plan and prepare for alternate methods of airway control