Nicolette Mosinski MPAS, PA-C
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1 Nicolette Mosinski MPAS, PA-C
2
3
4 1. Impaired respiratory effort 2. Airway obstruction
5 Observe patient for detection Rate Pattern Depth Accessory muscle use Evidence of injury
6 Noises Silent manifestations of complete obstruction
7 Head-Tilt Chin-Lift Jaw Thrust
8 Recognition of Airway Obstruction Opening the Airway Maintaining the Airway
9 Airway Adjuncts OPA Oropharyngeal Airway NPA Nasopharyngeal Airway
10
11 Intended to extend from the central incisor to just short of the epiglottis and posterior pharyngeal wall. Measure from the lips to the angle of the mandible 8-10cm = most adults
12
13 1. Techniques Inserted into the open mouth in an inverted position, with tip sliding along the palate. Upon complete insertion the device is rotated 180 degrees into position. The tongue is pulled forward with a tongue blade and the OPA is inserted in its normal orientation. 2. Insert NPA to adjunct OPA
14 Pushing the tongue posteriorly with insertion Using the incorrect size Trauma to the lips or tongue Using the device in a patient with intact reflexes
15
16 Diameter Size based on internal luminal diameter (about the size of one s pinky finger) Adult Length Flare end at tip of patients nose and distal tip reaching the angle of the mandible.
17 1. Coat NPA in watersoluble lubricant/anesthetic jelly 2. Insert device along the floor of the naris into he posterior pharynx behind the tongue
18 Using improper size Injury to the nasal mucosa Insertion in patient with basilar skull fracture
19 OPA More reliable airway maintenance Unresponsive patient NPA Better if gag or cough reflexes are intact. Semi-responsive patient Assist with OPA in unresponsive.
20 Indications: BMV is difficult / if intubation has failed Single attempt rescue device performed simultaneously with preparation for cricothyrotomy in the can t intubate, can t oxygenate Alternative to endotracheal intubation by advanced life support providers Alternative to endotracheal intubation for elective airway management in the operating room for appropriately selected patients Conduit to facilitate endotracheal intubation
21 No portion passes through the vocal cords. Laryngeal Mask Airway (LMA) Cobra PLA PeriLaryngeal Airway
22 Device passes behind the larynx to enter the upper esophagus King LT airway Easy Tube
23
24 Ruppert M, Reith MW, Widmann JH, et al. Checking for breathing: evaluation of the diagnostic capability of emergency medical services personnel, physicians, medical students, and medical laypersons. Ann Emerg Med 1999; 34:720. Vargo JJ, Zuccaro G Jr, Dumot JA, et al. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy. Gastrointest Endosc 2002; 55:826. Shorten GD, Opie NJ, Graziotti P, et al. Assessment of upper airway anatomy in awake, sedated and anaesthetised patients using magnetic resonance imaging. Anaesth Intensive Care 1994; 22:165. Mathru M, Esch O, Lang J, et al. Magnetic resonance imaging of the upper airway. Effects of propofol anesthesia and nasal continuous positive airway pressure in humans. Anesthesiology 1996; 84:273. Heimlich HJ. A life-saving maneuver to prevent food-choking. JAMA 1975; 234:398. Ingalls TH. Heimlich versus a slap on the back. N Engl J Med 1979; 300:990. Skulberg A. Chest compression--an alternative to the Heimlich manoeuver? Resuscitation 1992; 24:91. Redding JS. The choking controversy: critique of evidence on the Heimlich maneuver. Crit Care Med 1979; 7:475. Guildner CW. Resuscitation--opening the airway. A comparative study of techniques for opening an airway obstructed by the tongue. JACEP 1976; 5:588. Uzun L, Ugur MB, Altunkaya H, et al. Effectiveness of the jaw-thrust maneuver in opening the airway: a flexible fiberoptic endoscopic study. ORL J Otorhinolaryngol Relat Spec 2005; 67:39. Roberts K, Whalley H, Bleetman A. The nasopharyngeal airway: dispelling myths and establishing the facts. Emerg Med J 2005; 22:394. Stoneham MD. The nasopharyngeal airway. Assessment of position by fibreoptic laryngoscopy. Anaesthesia 1993; 48:575.
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