Airway and Breathing

Transcription

1 Airway and Breathing ETAT Module 2 Adapted from Emergency Triage Assessment and Treatment (ETAT): Manual for Participants, World Health Organization, 2005

2 Learning Objectives Accurately determine whether or not a patient s airway is patent and adequate. Accurately assess the effectiveness of the patient s breathing (oxygenation and ventilation). Effectively perform maneuvers to relieve choking. Effectively position the patient to open the airway (with and without possible cervical spine injury). Give supplemental oxygen. Effectively provide bag mask ventilation with and without airway adjuncts.

3 Target Audience Healthcare providers in any facility who are likely to manage sick patients, including physicians, nurses, and assistants. Teachers and trainers for healthcare professionals

4 Essential assessment questions Airway Breathing Is the patient breathing? Is the airway obstructed? Partial or complete? Is the patient blue? Does the patient have severe respiratory distress?

5 Airway and breathing: overview of assessment and management AB AIRWAY BREATHING Any positive signs Not breathing Central cyanosis (blueness) Severe respiratory distress Manage Open airway Give oxygen Keep patient warm

6 Overview of airway and breathing Is the airway obstructed? Is the obstruction partial or complete? Assessment: Is there a history of choking (as with foreign body)? Treatment: For complete obstruction, back slaps/chest thrusts or abdominal thrusts Position the airway Treatment: Chin lift Assessment: Is there a history of neck injury? Treatment: Jaw thrust rather than chin lift Is the patient breathing? Assessment: Look, listen, and feel Treatment: Bag mask ventilation Does the child have severe respiratory distress or cyanosis (blueness)?

7 Is the airway obstructed? Is there a history of choking? Sudden onset of symptoms. Associated with eating or foreign object in mouth. Is the obstruction complete? There is no sound, even though the child is appears to be coughing or choking. Is the obstruction partial? Audible crying, coughing, or choking.

8 Management of choking (complete airway obstruction) < 12 months Alternate Back slaps (5) and Chest thrusts (5) ETAT manual for participants, page 14

9 How to perform back slaps Lay infant on your arm or thigh with head down. Give 5 blows to back with heel of hand. ETAT manual for participants, page 14

10 How to perform chest thrusts From the back slap position, turn the infant over, keeping the head down. With two fingers, perform 5 chest thrusts in the midline just below the nipple line. Circulation 2005;112:IV-156

11 Back slap chest thrust sequence for choking child < 12 months Infant with a history of choking is not breathing. Deliver 5 back thrusts. Assess breathing. Obstruction persists, deliver 5 chest thrusts. Assess breathing. Obstruction persists, check mouth and remove any visible foreign body. Assess breathing. Obstruction persists. Continue to deliver alternating back slaps and chest thrusts, checking the mouth after each series of chest thrusts.

12 Demonstration Choking manoeuveres for infants < 12 months

13 Management of choking (complete airway obstruction) > 12 months Abdominal thrusts (Heimlich manoeuvre) ETAT manual for participants, page 15

14 How to perform abdominal thrusts Go behind patient. Pass your arms around the patient s body. Immediately below the patient s sternum, make a fist with one hand and place the other hand over it. Pull inward and upward into the patient s abdomen. Repeat this manoeuvere 5 times. If obstruction persists, check the patient s mouth and remove visible obstructions.

15 Demonstration Choking manoeuveres for children > 12 months

16 Positioning the airway The most common cause of upper airway obstruction is the tongue. Use chin lift for patients without concern for neck trauma. ETAT manual for participants, page 15

17 2008 UpToDate

18 Position airway with neck injury For patients who may have neck injury, you must NOT move the neck. Use jaw thrust. ETAT manual for participants, page 16

19 2008 UpToDate

20 Demonstration Positioning the airway

21 Is the patient breathing? Look Active, crying, talking? Chest wall moving? Color? Listen Any breath sounds? Are they normal? Feel Can you feel the breath at the nose or mouth? ETAT manual for participants, page 17

22 Is there increased work of breathing? Can child talk or nurse? Signs of distress Anxious Nasal flaring Indrawing of chest Between the ribs Below the breast bone PALS: Rapid Cardiopulmonary Assessment, American Heart Association 2001

23 What is the rate and pattern of breathing? Too fast Too slow Agonal breathing: irregular, slow Abnormal patterns Deep, slow (as with acidosis) Irregular (as with brain abnormalities)

24 Assess for fast breathing Manual for health care of children in humanitarian emergencies, WHO 2008, page 7

25 Are there abnormal sounds? Stridor: upper airway obstruction (foreign body, croup) Wheezing: lower airway obstruction (bronchospasm) Grunting: increased end expiratory pressure (pneumonia)

26 Who needs oxygen? Any patient with airway or breathing problems Patients with shock Children with severe anemia (< 5 gm Hb) They will not show cyanosis

27 Oxygen sources Refillable cylinders Oxygen concentrator Portable Require reliable oxygen source to refill Flammable hazard Can supply 95% oxygen Requires electricity Requires maintenance

28 Oxygen delivery systems Nasal prongs Blow by Mask Simple Non-rebreather ETAT manual for participants, page 21

29 Patient not breathing: needs ventilation Bag Mask Ventilation

30 2008 UpToDate

31 Proper airway positioning Proper positioning aligns the oral (O), pharyngeal (P), and tracheal (T) axes to open the airway.

32 Bag mask ventilation EC clamp technique Oxygen source Delivering breaths Deliver slowly (over one second) Rate: 12 to 20 per minute

33 Airway adjuncts Oral airway Nasal airway Can only be used in unconscious patients. Tongue can be inadvertently pushed into the hypopharynx, causing obstruction. Can be used for conscious patients.

34 Demonstration Bag Mask Ventilation

35 When management resources are limited Use guidelines from Integrated Management of Childhood Illness (IMCI). IMCI chartbook uses the same assessment and classification principles as ETAT. Management recommendations emphasize recognizing patients that should be stabilized and transferred.

36 Assessment and classification: IMCI under 2 months ABCD Severe disease OR Local bacterial infection Positive sign Not feeding well OR Convulsion OR Rapid breathing OR Severe chest indrawing OR Fever OR low temperature Poorly responsive Manage Keep patient warm (skin to skin) Give first dose of antibiotic Refer urgently to hospital

37 Airway and breathing: IMCI 2 months to 5 years AB AIRWAY BREATHING Positive signs Cyanosis Chest indrawing Stridor at rest Manage Keep patient warm Give first dose of antibiotic Refer urgently to hospital

38 Summary Obstructed airway Not breathing Choking manoeuvers Ventilate Hypoxia Severe respiratory distress Give oxygen Give oxygen, Ventilate