Transcript Basic airways management

Basic Airways
Management
2015/7/18
© Dr Paul Bradley, Clinical Skills
Resource Centre, University of
Liverpool, UK
1
Recognition of Airways Obstruction
Look - for chest and abdominal movement
Listen - for air-flow at mouth and nose
Feel - for airflow against cheek
Partial obstruction
air movement may be reduced and is usually noisy
• “gurgling”
• “snoring”
• “crowing”
2015/7/18
- suggest liquid in upper airway
- suggests tongue partially obstructing
pharynx
- suggests laryngeal obstruction
© Dr Paul Bradley, Clinical Skills
Resource Centre, University of
Liverpool, UK
2
Head Tilt - Chin Lift
Head tilt stretches anterior neck
muscles, lifts tongue away from
posterior pharyngeal wall and
epiglottis away from laryngeal
inlet
Chin lift stretches structures more
and pulls mandible and tongue
forward
If neck injury suspected, do not tilt
the head unless jaw thrust fails
Death from hypoxic airway
obstruction is much more common
then quadriplegia resulting from
emergency airway manipulation
2015/7/18
© Dr Paul Bradley, Clinical Skills
Resource Centre, University of
Liverpool, UK
3
Jaw Thrust
An alternative to head tilt chin lift
Technique of choice where
there is a strong suspicion of
cervical spine injury (e.g.
RTA, falls, drowning or
diving accidents)
Place fingers behind angle of
jaw and apply upward and
forward pressure
Hold mouth slightly open
using thumbs to displace
chin inferiorly
2015/7/18
© Dr Paul Bradley, Clinical Skills
Resource Centre, University of
Liverpool, UK
4
Using a Face-mask
A pocket face mask allows easier
ventilation with jaw thrust and
can be used with head tilt - chin
lift
Non-return valve prevents rescuer
from re-breathing victim’s
expired air
Removes need for mouth to
mouth ventilation, but administers
only 16% O2 concentration
Adding high flow (10-15
litres/min) oxygen can improve
oxygenation markedly (45-50%
© Dr Paul Bradley, Clinical Skills
Resource Centre,
University of
concentration)
2015/7/18
Liverpool, UK
5
Technique of using face-mask
Apply mask to face using thumbs
of both hands
Lift jaw using pressure applied to
angles of the jaw by fingers
Blow through inspiratory valve
Watch chest rise and fall
Any leaks can be reduced or
abolished by adjusting position
of mask, contact pressure,
position of digits or altering jaw
thrust
Apply oxygen via input nipple at
© Dr Paul Bradley,
Clinical
Skills
10-15
litres/min
if available
2015/7/18
Resource Centre, University of
Liverpool, UK
6
Simple airway adjuncts
Simple airway adjuncts may assist maintenance of an
airway in either the spontaneously breathing or ventilated
patient
May be useful if prolonged resuscitation is undertaken
without formal endotracheal intubation
These do not preclude the need to maintain head tilt-chin
lift or jaw thrust
The two commonest are the Guedal (oropharyngeal) and
the nasopharyngeal airways
Guedal airways come in sizes suitable for neonates up to
adults (adult sizes are 2,3 and 4 for small to large adults)
Oropharyngeal airways are 6-8mm in diameter
2015/7/18
© Dr Paul Bradley, Clinical Skills
Resource Centre, University of
Liverpool, UK
7
Oropharyngeal airways
Curved plastic tubes
Size = corner of mouth to angle of jaw
Should only be used in the unconscious
patient as stimulation of the gag-reflex
may result in vomiting and stimulation of
the laryngeal-reflex may result in
laryngospasm
Open mouth and ensure no foreign
material
Introduce into oral cavity inverted
Rotate through 180° as passes below
palate
Any coughing or retching should prompt
removal of the airway
After insertion check airway with “look,
listen,Clinical
feel” Skills
© Dr Paul Bradley,
2015/7/18
Resource Centre, University of
Liverpool, UK
8
Nasopharyngeal airway
Often better tolerated then Guedal airway
May be lifesaving in people with clenched
jaws, trismus or jaw injuries
Should NOT be used where there is evidence
of fracture of the base of the skull
Size to use = diameter of patient’s little
finger
Insert safety pin through flange, lubricate
airway
Check nostril patency
Insert airway bevel end first, pass vertically
along floor of the nose using slight rotation
If obstruction felt, try other nostril
Tip should lie in the pharynx
Once in place “look, listen, feel”
2015/7/18
© Dr Paul Bradley, Clinical Skills
Resource Centre, University of
Liverpool, UK
9
Bag-mask
Applied to face
Contact and jaw lift are
maintained with one hand
Other hand used to squeeze bag
(the inexperienced may require
an extra person to squeeze the
bag)
Watch chest rise and fall
Delivers 21% oxygen
Attaching oxygen at a high flow
can raise concentration to 5055%
© Dr Paul Bradley, Clinical Skills
2015/7/18
Resource Centre, University of
Liverpool, UK
10
Bag-mask-reservoir
The addition of a
reservoir to the maskbag-oxygen
arrangement
Raises oxygen
concentration to
approx.. 90% with a
high-flow rate
2015/7/18
© Dr Paul Bradley, Clinical Skills
Resource Centre, University of
Liverpool, UK
11
Delivery of oxygen
Method
2015/7/18
O2 concentration
Mouth to mouth
16%
Mouth to mask
16%
Mouth to mask with O2
attached (10-15l/min)
Mask and bag
45-50%
Mask and bag mask with
O2 attached (10-15l/min)
Mask and bag mask with
reservoir and O2 attached
(10-15l/min)
50-55%
21%
90%
© Dr Paul Bradley, Clinical Skills
Resource Centre, University of
Liverpool, UK
12