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Airway Management
Airway Management
Airway Management
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Intended Learning Outcomes OVERVIEW
Describe common conditions that may result in airway Respiratory Revision
compromise
Nursing Assessment Airway
Artificial Airways
Describe the recognition and management of clinical
manifestations associated with airway compromise and altered
oxygenation.
Describe the management of respiratory support therapies
including artificial airways.
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A Brief Revision A Brief Revision
Ventilation: Inspiration:
Movement of air in and out of lungs Stimulus from respiratory centre in medulla)
Transmitted via phrenic nerve to diaphragm, spinal cord/intercostal nerves
to intercostal muscles
Controlled via:
Diaphragm contracts, flattens
• Respiratory centre in Medulla
Intercostal muscles contract; ribs move up and out
• Apneustic & pneumotaxic centres in Pons Air spaces in lungs increase in volume
(pneumotaxic centre regulates rate of breathing; apneustic centre regulates depth of intrapulmonic pressure (pressure gradient from 760mmHg to 758mmHg)
inhalation & exhalation)
Air flows into airways, alveoli inflate until pressure equalizes
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A Brief Revision A Brief Revision
Expiration:
Stretch receptors in lungs signal respiratory center via vagus
nerve to inhibit inspiration
Natural elasticity of lungs pulls diaphragm, chest wall to resting
position
Pulmonary air spaces decrease in volume
Intrapulmonary pressure rises
Air flows out until pressure equalizes
http://hubpages.com/education/Pulmonary‐Mechanics#
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A Brief Revision A Brief Revision
Respiration:
Exchange of gases at a molecular level between the living organism
and the environment
External Respiration:
Exchange between lungs, blood cells
Internal Respiration:
Exchange between blood cells and tissues
http://www.austincc.edu/apreview/PhysText/Respiratory.html
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Airway Assessment Breathing Assessment
Any form of respiratory distress/dyspnoea can quickly become a life Presence or absence ?
threatening situation.
Rate Decreased
Any form of respiratory compromise must be assessed and managed quickly. Increased
Quality Irregular
• Is the patient unconscious or conscious? Shallow
Deep
• LOOK – for chest/ abdominal movement Skin Colour
• LISTEN – at mouth and nose for breath sounds, snoring, gurgling Use of Accessory Muscles
• FEEL – at mouth and nose for expired air Bilateral Breath sounds
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Airway Management Airway Management
Head Tilt/Chin Lift:
Helping to establish and maintain a patients airway The technique most commonly used are the Backward Head Tilt in combination
may be as simple as positioning the patient, with Chin Lift for Adults. The Australian Resuscitation Council advise head tilt‐
using head tilt or jaw thrust techniques, but may chin lift for ALL victims. Jaw thrust without extension if C‐spine injury is
suspected. (ARC Guideline 4, 2014)
also involve employing suction, or inserting an
artificial airway
According to the ARC, airway management is
required to provide an open airway when the
victim:
• is unconscious;
• has an obstructed airway;
• needs rescue breathing.
(ARC Guideline 4, 2014)
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Airway Management Airway Management
Jaw Thrust: Suction:
The mechanical removal of airway compromising fluid products such as sputum, blood
or vomitus through the use of suction – either with a Yankauer sucker or a ‘Y’ sucker.
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Airway Management Airway Management
Artificial airways: Oropharyngeal/Guedel's Airway.
• An Oropharyngeal (aka Guedel’s) airway is a short, curved, hard
plastic tube.
• It is inserted between the teeth and extends over the back of the
tongue
• Usually used as a short term measure to protect the airway in the
unconscious pt who has a diminished or absent gag reflex and/or
to prevent the tongue from occluding the airway
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Airway Management Airway Management
Artificial airways: Nasopharyngeal Airway
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Airway Management Airway Management
Laryngeal Mask Airway:
• A Laryngeal Mask Airway (LMA) consists of a tube with an inflatable
elliptical cuff that is blindly inserted into the pharynx and is advanced
to sit just above the larynx.
• Once placed, the cuff around the mask is inflated with air to create a
tight seal around the larynx, allowing the use of PPV
• The LMA is generally used in situations of elective anaesthesia, but
may be used in any situation where invasive airway protection is
required but intubation is inappropriate or unable to be achieved
promptly
• Use of an LMA does not protect the airway from aspiration of gastric
content
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Airway Management Airway Management
Endotracheal Tube:
• An endotracheal tube (ETT) is a curved plastic tube that may introduced
into the pt’s airway either orally or nasally
• This is done to allow the application of PPV in a setting of respiratory
failure or airway compromise
• The ETT is passed over the back of the tongue and through the vocal
cords into the upper trachea by the MO, using a laryngoscope
• Once placed, confirmation of placement is first confirmed at the bedside
using a stethoscope to ascertain bilateral air entry
• The ETT is then securely fixed in place and placement is confirmed via CXR
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Airway Management Airway Management
Tracheostomy:
• A Tracheostomy is a surgical opening made in the trachea through which a
tracheostomy tube is inserted in order to facilitate airway management.
• The tube allows air to enter the trachea and lungs directly, and so bypasses
the nose, pharynx and larynx
• This procedure may be performed for a number of reasons, and has varied
physiological and psychological implications for the patient.
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References
Aitken, L., Marshall, A. & Chaboyer, W. (2015) ACCCN’s Critical Care Nursing (3rd ed). Mosby
Elsevier, Sydney.
Australian Rescucitation Council (2014) Guideline 4: Airway. Available at:
http://resus.org.au/guidelines/
Australian Rescucitation Council (2014) Guideline 11.6.1: Targeted oxygen therapy in adult
advanced life support. Available at: http://resus.org.au/guidelines/
McCance, K., Huether, S.,Brashers, V. & Rote, N. (2010) Pathophysiology: the biological basis for
disease in adults & children (6th ed). Missouri: Mosby.
Meier, P., Ebrahim, S., Otto, C. & Casas, J. (2013) Oxygen therapy in acute myocardial infarction –
good or bad? [editorial]. Cochrane Database of Systematic Reviews 2013;(8):
http://www.cochranelibrary.com/editorial/10.1002/14651858.ED000065
Urden, L., Stacy, K. M., & Lough, M. E. (2014). Thelan’s critical care nursing (7th ed). St Louis:
Elsevier Mosby.
With thanks to Jessica Denney, La Trobe University.
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