Adult and Pediatric Airway

Course overview

Objectives Identify the main anatomical structures of the upper and lower airway Describe the process of ventilation and respiration and basic techniques to manage the airway when there is an obstruction of either Identify key differences in managing adult v pediatric airways Content 1 Respiratory System 2 Airway Anatomy 3 Upper Airway Tract 1 Nose 2 Mouth and oral cavity 1 Alternate airway especially in emergency 2 Entrance to the digestive system 3 Also involved in the production of speech 3 Tongue 3 Jaw 4 Throat pharynx 1 Oropharynx 2 Epiglottis 3 Larynx voice box 1 vocal cords 2 thyroid cartilage 3 cricoid cartilage 4 Lower Airway Tract 1 Trachea windpipe 1 Hollow tube which passes air to the lower airways 2 Supported by cartilage rings 2 Bronchi 1 Hollow tubes which further divide into lower airways of the lungs 2 Supported by cartilage 3 Lungs 1 Bronchioles 1 thin hollow tubes leading to the alveoli 2 remain open through smooth muscle tone 2 Alveoli 1 the end of the airway 2 millions of thin walled sacs 3 each alveolus surrounded by capillary blood vessels 4 site where oxygen and carbon dioxide waste are exchanged 5 Physiology of Respiration 6 Pulmonary Ventilation 1 Ventilation is defined as the movement of air into and out of the lungs 2 Patients with adequate ventilation are moving normal or near normal volumes of air into and out of the lungs 7 Oxygenation 1 Refers to the amount of oxygen dissolved in blood and body fluids 2 Blood that is almost fully saturated with oxygen might be described as well oxygenated blood 8 Respiration 1 The process by which the body captures and uses oxygen and disposes of carbon dioxide 9 Airway Assessment 1 Unresponsive Patient 1 Medical patients 1 Open and maintain the airway using head tilt chin lift technique 2 Trauma patients 1 Open and maintain the airway using modified jaw thrust technique while maintaining manual cervical stabilization 2 Responsive Patient 1 If the patient speaks the airway is functional but may still be at risk 2 Foreign body or substances in the mouth may impair the airway and must be removed 1 Finger sweep solid objects 2 Suction liquids 3 If the upper airway becomes narrowed inspiration may produce a high pitched whistling sound known as stridor 3 Airway patency must be continually reassessed 4 Breathing status 1 Normal adult breathing 2 Abnormal adult breathing 1 Characteristics the respiratory rate is too fast or too slow for the age of the patient 3 Rate issues 1 Breathing is too fast for the age of the patient 2 Breathing is too slow for the age of the patient 3 Does verbal or painful stimulus increase the rate to normal 4 Assist breathing with a bag mask with supplemental oxygen 5 Treat patients who are occasionally gasping as if they were not breathing at all 6 If breathing is absent assist ventilation with a pocket mask or bag mask with supplemental oxygen 7 Chest rise and fall is shallow 8 Breathing is noisy 1 Gurgling noise without secretions in the mouth 2 Wheezing 10 Effort of breathing 1 Accessory muscles 1 Neck 2 Between ribs 3 Abdomen 2 Nasal flaring 3 Tripod position 11 Management of Adequate and Inadequate Respiration 1 Manual Airway Maneuvers 1 Head tilt chin lift 1 Purpose 2 Indications 3 Contraindications 4 Complications 5 Procedure 6 Limitation 2 Jaw thrust maneuver 1 To open airway when cervical spine injury is suspected 2 Procedure 3 If airway is not open and jaw thrust maneuver does not open it use head tilt chin lift maneuver 3 Modified chin lift 1 Purpose 2 Indications 3 Contraindications 4 Complications 5 Procedure 6 Limitation 2 Mechanical Airway Devices 1 Oropharyngeal 1 Purpose 2 Indications 3 Contraindications 4 Complications 5 Procedure 6 Limitations 12 Oxygen Delivery Devices 1 Nasal cannula 1 Purpose 2 Indications 3 Procedure 4 Limitation 2 Non Rebreather NRB Mask 1 Purpose 2 Indications 3 Procedure 4 Limitation