Emergency Resuscitation Equipment

Cause for upper airway obstruction
-soft tissue (unconscious)
-secretions
-foreign bodies
-bleeding
-Edema
-Tumors

Partial Vs Complete obstruction
-some air movement Vs. no air movement

Partial airway treatment
-allow them to clear on their own

Complete airway treatment
-give heimlich
-pregnant give chest thrusts
-infants give back blows

Artificial Airways
-oropharyngeal (teeth to jaw)
-nasopharyngeal (nares to ear lobe)
-laryngeal mask airways LMA
-esophageal-tracheal combitude ETC
-king airway

Combitube has
-2 tubes and 2 cuffs

King Airway
-similar to an ETC but only has one tube and 2 cuffs
-goal is to get into esophagus

ETT Indications
-upper airway obstruction
-protect the airway
-facilitate suctioning
-manual and mechanical ventilation

ETT Hazards
-infection
-vocal cord trauma
-interferes with cough
-disables speech
-tube may become occluded with secretions

4 Airway reflexes
-pharyngeal (swallow/gag)
-laryngeal (vocal cords)
-tracheal (cough)
-carinal ( triggers a cough)

ETT components
-tube markings ( inner and outer diameter)
-length markings (20-24 cm)
-Pilot line, valve, tube and balloon
-murphy eye
-cuff
-radiopaque marker

Implant Testing or IT on a EET is done by the
Z-79 committee

Ideal Safe Cuff Pressure
– less than 25cmH20 ideally 20 cmH20

Mallampati Scoring
Score used to evaluate the degree to which the posterior pharynx is visible (smaller the number the easier for intubation)

Macroglossia
enlarged tongue

Bull neck
-decreased movement makes intubation more difficult

Dental work or loose teeth can be a hazard because
-the loose tooth can be knocked out by the laryngoscope and the pt may aspirate.

Thyromental Distance
-distance from the chin to the thyroid. should exceed 6 mm or 3 fingers breadths

Dentures with intubation
-must be removed for intubation but during bag mask ventilation they should be left in for a better seal.

Intubation Equipment
-Laryngoscope (Mcintosh blade is curved, Miller is straight)
-Magill forceps
-stylet
-10 mL syringe
-Yankauer suction
-ET holder/tape
-BVM unit with 02
-Colorimetric Capnograph

Oral Intubation Procedure (Orotracheal)
-assemble and check equipment
-position Pt.
-preoxygenate and ventilate Pt.
-insert laryngoscope
-visualize glottis
-displace epiglottis
-Insert tube
-assess tube position ( 2-3 cm above carina)
-stabalize tube and confirm placement (capnograph, chest wall expansion, bilateral BrS)

Nasal Intubation
Nasal Intubation

Oral Intubation
Oral Intubation

Esophageal detection device (EDD)
-device used to detect tracheal or esophageal intubation.
-bulb will reinflate if in the trachea
-bulb will stay deflated if in the esophagus

Airway trauma caused by tracheal tubes
-laryngeal lesions

most common injuries to the larynx are
-glottic edema
-vocal cord inflammation
-coval cord polyps or granulomas
-vocal cord ulcerations

Less common but more serious laryngeal lesions would be
-cord paralysis
-stenosis

Tracheal Lesions
-granulomas
-tracheomalacia
-treacheal stneosis

Prevention of airway trauma
-tube movement is primary cause of injury
-sedation can help avoid self extubation
-swivel adapter reduces traction
-correct airway size
-maintain pressure of < 25 cm H20 or < 20 torr with a seal

Tube obstructions
-kinking or biting tube
-herniation of cuff
-tube against wall of trachea
-mucus plug

Extubation
-removal of the ET tube

Extubation equipment
-blue pad
-02 device
-10 ml syringe
-yankauer suctioning
-stethoscope
-BMV

Extubation procedure
-identify the PT.
-gather supplies
-explain procedure
-suction both airway and back of throat
-remove ET tube holder
-deflate the cuff
-3 big breaths and remove tube on 3
-evaluate the pt. by asking them to speak/cough
-listen to their throat and chest

Complications of extubation
-vocal cord polyps
-mucosal ulcerations
-tracheomalacia
-tracheostenosis

Decannulation
-removal of a tracheostomy tube

Indication for tracheostomy
-upper airway obstruction preventing intubation
-avoids oral/nasal tubes complications (comfort, eat, speech, decreased sedation)
-weaning is easier
-Resp. Failure
-OSA
-pulmonary hygiene
-trauma

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