1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. SECTION 3 Emergency Management

3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 20 Emergency Airway Management

4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Anatomy of the Upper Airway Tongue Vallecula Epiglottis Arytenoid cartilages Vocal cords

5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Reflexes of the Upper Airway Swallow Gag Laryngeal Tracheal Carinal

6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Upper Airway Obstruction Positional maneuvers to open the airway –Head tilt –Anterior mandibular displacement –Triple airway maneuver Total airway obstruction may lead to death in 5 to 10 ‑ minutes.

7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Resuscitators Main types of manual resuscitators: –Self-inflating –Flow-inflating Gas-powered resuscitators –Operate using a 50 ‑ psi oxygen source

8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Intubation: What is it? The placement of an endotracheal tube into the trachea –Oral Fastest and most direct –Nasal Only used if oral route is impractical or impossible

9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Equipment for Endotracheal Intubation Laryngoscopes –Conventional –Fiberoptic Blades –Miller –Macintosh

10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Endotracheal Tubes Murphy eye endotracheal tube Endotracheal tube cuff Pilot tube and balloon

11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Complications of Intubation Early complications –Esophageal intubation –Trauma to dentition or oral cavity –Mainstream bronchus intubation –Aspiration and vomiting

12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Complications of Intubation Late Complications –Vocal cord damage –Tracheal stenosis –Tissue necrosis –Infection

13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Extubation Once the patient is able to manage secretions or the underlying cause for intubation has been resolved, extubation may be performed. –Spontaneous breathing trial to determine readiness for extubation

14 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Airway Insertion Insertion of the nasopharyngeal airway –Contraindicated for patients receiving anticoagulant therapy or those who have bleeding disorders Insertion of the oropharyngeal airway –Should not be used if its placement stimulates gagging and vomiting

15 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Preparation of Manual Resuscitators To prepare a manual resuscitator: –Check the valves, –Attach the reservoir assembly to the manual resuscitator, –Attach the oxygen connecting tubing to an oxygen flowmeter, –Reassess the operation of the valves, –Occlude the patient outlet, and squeeze the bag.

16 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Ventilation with a Manual Resuscitator Position the patient in a supine position. Place the mask on the patient. Begin ventilation. Observe the patient.

17 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Equipment Preparation and Assembly for Intubation Preparation of the laryngoscope Oropharyngeal airways Yankauer suction 10-ml (or larger) syringe Commercial endotracheal tube holder Water-soluble lubricant Endotracheal tubes Stylet