Chapter 10; Airway Management

Please take a moment to check your understanding of performing one-rescuer bag-valve mask ventilations. Write the steps you learned in the Skill Drill and then compare your answer. 4 Steps

1. Assemble your equipment and position yourself above the patient's head. Open the airway using the head tilt-chin lift or jaw-thrust maneuver 2. Open the patient's mouth and suction as necessary to clear secretions. Insert an oral or nasal airway 3. Select the appropriate mask and position it properly on the patient's face. Following the EC-clamp method, make a seal by holding your index finger over the lower part of the mask and your thumb over the upper part of the mask. Then, use your remaining fingers to pull the lower jaw into the mask. Bring the lower jaw up to the mask with the last three fingers of your hand. Avoid the fleshy soft tissue of the neck 4. Squeeze the bag with your other hand until you see adequate chest rise. For adults, squeeze once every 5 seconds. For infants and children, squeeze once every 3 seconds. In patients with ongoing CPR and an advanced airway in place, use a rate of 1 breath every 6 seconds

Please take a moment to check your understanding of performing pulse oximetry. Write the steps you learned in the Skill Drill and then compare your answer. 2 Steps

1. Clean the patient's finger and place the index or middle finger into the pulse oximeter probe. Turn on the pulse oximeter, and note the LED reading of the SpO2 2. Palpate the radial pulse to ensure it correlates with the LED display on the pulse oximeter

Please take a moment to check your understanding of inserting an oral airway with a 90-degree rotation. Write the steps you learned in the Skill Drill and then compare your answer 3 Steps

1. Depress the tongue so that it remains forward 2. Insert the oral airway sideways from the corner of the mouth, until the flange reaches the teeth 3. Rotate the oral airway at a 90-degree angle. Remove the bite stick as you exert gentle backward pressure on the oral airway until it rests securely in place against the lips and teeth

Please take a moment to check your understanding of positioning an unconscious patient. Write the steps you learned in the Skill Drill and then compare your answer. 4 Steps

1. Kneel beside the patient. Support the head while your partner straightens the patient's leg 2. Have your partner place his or her hand on the patient's far shoulder and hip 3. Roll the patient as a unit with the EMT at the patient's head calling the count to begin the move 4. Open and assess the patient's airway and breathing status

Please take a moment to check your understanding of suctioning an airway. Write the steps you learned in the Skill Drill and then compare your answer. 4 Steps

1. Make sure the suctioning unit is properly assembled and turn it on. Clamp and tubing and make sure that the unit generates a vacuum of more than 300 mm Hg 2. Measure the catheter from the corner of the mouth to the earlobe of the jaw 3. Turn the patient's head to the side (unless you suspect cervical spine injury), open the mouth using the cross-finger technique or tongue-jaw lift, and insert the catheter to the predetermined depth without suctioning 4. Apply suction in a circular motion as you withdraw the catheter. Do not suction an adult for more than 15 seconds

Please take a moment to check your understanding of performing mouth-to-mask ventilation. Write the steps you learned in the Skill Drill and then compare your answer. 3 Steps

1. Once the patient's head is properly positioned and an airway adjunct is inserted, place the mask on the patient's face. Seal the mask to the face using both hands (EC-clamp method) 2. Breathe into the one-way valve until you note visible chest rise 3. Remove your mouth and watch the patient's chest fall during exhalation

Please take a moment to check your understanding of inserting an oral airway. Write the steps you learned in the Skill Drill and then compare your answer 3 Steps

1. Size the airway by measuring from the patient's earlobe to the corner of the mouth 2. Open the patient's mouth with the cross-finger technique. Hold the airway upside down with your other hand. Insert the airway with the tip facing the roof of the mouth 3. Rotate the airway 180 degrees. Insert the airway until the flange rests on the patient's lips and teeth. In this position, the airway will hold the tongue forward

Please take a moment to check your understanding of inserting a nasopharyngeal airway. Write the steps you learned in the Skill Drill and then compare your answer 4 Steps

1. Size the airway by measuring from the tip of the nose to the patient's earlobe. Coat the tip with a water-soluble lubricant 2. Insert the lubricated airway into the larger nostril with the curvature following the floor of the nose. If using the right nare, the bevel should face the septum. If using the left nare, insert the airway with the tip of the airway pointing upward, which will allow the bevel to face the septum 3. Gently advance the airway. If using the left nare, insert the nasopharyngeal airway until resistance is met, then rotate the nasopharyngeal airway 180 degrees into position. This rotation is not required if using the right nostril 4. Continue until the flange rests against the nostril. If you feel any resistance or obstruction, remove the airway and insert it into the other nostril

Please take a moment to check your understanding of using CPAP. Write the steps you learned in the Skill Drill and then compare your answer 6 Steps

1. Take standard precautions. Confirm blood pressure. Check your equipment, then connect the circuit to the CPAP generator 2. Connect the face mask to the circuit tubing 3. Connect the tubing to the oxygen tank 4. Confirm that the device is on before you apply it to the patient's face. Place the mask over the patient's mouth or nose or allow the patient to hold it to his or her mouth and nose 5. Use the strapping mechanism to secure the CPAP to the patient's head. Make sure there is a tight seal 6. Adjust the pressure valve and the FIO2 according to the manufacturer's recommendations to maintain adequate oxygenation and ventilation. Reassess the patient

Please take a moment to check your understanding of placing an oxygen cylinder into service. Write the steps you learned in the Skill Drill and then compare your answer 4 Steps

1. Using an oxygen wrench, turn the valve counterclockwise to slowly "crack" the cylinder 2. Attach the regulator/flowmeter to the valve stem using the two pin-indexing holes and make sure that the washer is in place over the larger hole 3. Align the regulator so that the pins fit snugly into the correct holes on the valve stem, and hand tighten the regulator 4. Attach the oxygen connective tubing to the flowmeter

When testing a mechanical suctioning unit, you should turn on the device, clamp the tubing, and ensure that it generates a vacuum pressure of more than:

300 mm Hg

You are performing mouth-to-mask ventilations with oxygen connected and set at a flow rate of 15 L/min. What percentage of oxygen is your patient receiving?

55%

Which of the following patients should you place in the recovery position?

A 31 year old semiconscious male with low blood sugar and adequate breathing

In which of the following patients would the head tilt-chin lift maneuver be the MOST appropriate method of opening the airway?

A 37 year old female who is found unconscious in her bed

Which of the following patients is breathing adequately?

A conscious male with respirations of 19 bpm and pink skin

Rearrange the oxygen delivery devices in the correct order based on the percentage of oxygen delivered, from highest to lowest.

BVM with reservoir Nonrebreathing mask with reservoir Mouth-to-mask device Nasal cannula

Which structure is not found in the upper airway?

Bronchus

A man was found unresponsive in his bed at home. There is no evidence of injury and the patient's medical history is not known. The patient's face is cyanotic, yet the pulse oximeter reads 98%. Which of the following would MOST likely explain this?

Carbon monoxide poisoning

What is the main problem with positive-pressure ventilation?

Cardiac output drops

Irregular respirations characterized by an increasing rate and depth of breathing followed by periods of apnea are called:

Cheyne-Stokes respirations

________ are an irregular respiratory pattern in which the patient breathes with an increasing rate and depth of respirations, followed by a period of apnea, followed again by a pattern of increasing rate and depth of respiration.

Cheyne-Stokes respirations

A portable suctioning unit should generate an airflow of more than 40 L/min and a vacuum of more than 300 mm Hg when the tubing is clamped.

False

Which of the following is contraindicated in a patient who has sustained a head injury?

Insertion of an nasal airway

How does CPAP improve oxygenation and ventilation in patients with certain respiratory problems?

It forces the alveoli open and pushes oxygen across the alveolar membrane

What is the preferred method of ventilating a patient?

Mouth-to-mask with one-way valve

Which of the following is used with an unresponsive patient or a patient with an altered level of consciousness who has an intact gag reflex and is not able to maintain his or her airway spontaneously?

Nasopharyngeal airway

You respond to a construction site and find a worker lying supine in the dirt. He has been hit by a heavy construction vehicle and flew more than 15 feet (4.6 m) before landing in his current position. There is discoloration and distention of his abdomen about the right upper quadrant. He is unconscious and his respirations are 10 breaths/min and shallow, with noisy gurgling sounds. What method will you use to keep his airway open?

Oropharyngeal airway

Which of the follow statements regarding normal gas exchange in the lungs is correct?

Oxygen and carbon dioxide diffuse across the alveolar walls and capillaries

Which of the following statements regarding oxygen is correct?

Oxygen supports the combustion process and may cause a fire

Which of the following statements regarding breathing adequacy is correct?

Patients breathing shallowly may require assisted ventilation despite a normal respiratory rate

How can gastric distention be prevented when performing artificial ventilations?

Provide slow, gentle breaths during artificial ventilation over 1 second

You are assisting ventilations with a BVM and notice the patient's chest does not rise and fall with each ventilation. What should you do?

Reposition the airway by bringing the head back to a neutral position, then reopen the airway and attempt to ventilate

While you are performing artificial ventilations on a patient, he vomits. What should you do?

Roll the patient onto his side to allow for drainage of emesis

Which of the following is an indication of poor air exchange?

Stridor

What is respiration?

The exchange of oxygen and carbon dioxide in the alveoli and tissues

Which of the following are disadvantages of a manually triggered ventilation device?

The high ventilatory pressures generated may damage lung tissue if not carefully monitored. Has a high incidence of gastric distention and possible damage to structures within the chest cavity. Should not be used on patients with COPD or suspected cervical spine or chest injuries

A tonsil-tip catheter is the best kind of catheter for infants and children.

True

Never suction the mouth or nose of a child for more than 15 seconds.

True

You should repeat suctioning only after the patient has been adequately ventilated and reoxygenated.

True

During your assessment of a patient with respiratory distress, you hear wheezing when listening to breath sounds. This indicates:

a lower airway obstruction

Which of the following is the most reliable indicator of adequately performed bag-valve mask ventilation in an apneic adult with a pulse?

adequate rise of the chest when squeezing the bag

What occurs when a patient is breathing very rapidly and shallowly?

air moves primarily in the anatomic dead space and does not participate in pulmonary gas exchange

The nasopharyngeal airway is most beneficial because it

can maintain a patient airway in a semiconscious patient with a gag reflex

A patient who is suspected of being hypoxic and is breathing adequately should be given supplemental oxygen with a:

nonrebreathing mask

A 19-year-old female is found unconscious by her roommate. Your primary assessment reveals that her breathing is inadequate. As you insert an oropharyngeal airway, she begins to gag violently. You should:

remove the airway and be prepares to suctions her oropharynx

You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent this, you should:

seal the mouth and nose

Excellent indicators of respiration include level of consciousness and what else?

skin color

The physical act of moving air into and out of the lungs is called:

ventilation