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Respiratory & Airway Part Five

Airway Adjuncts: Maintain a patent airway

Oropharyngeal- measure corner of mouth to earlobe. Patient must have no gag reflex.
Use with a BVM, counters obstruction of tongue, facilitates suction.
Doesn’t isolate trachea, can’t have clenched teeth. For pediatric use a tongue blade, it must be the right size

Nasopharyngeal – measure tip of nose to earlobe, size of pinky, stretch to just below the
base of tongue. Patient can have gag reflex/clenched teeth but no skull fractures, nasal obstructions, or nosebleeds/injury

Advanced Airways – intubation is the best way to secure an airway. Use an ET (endotracheal within or through the trachea) tube. Use when:

• Unresponsive patient and other methods don’t work
• Patient can’t protect the airway
• Prolonged artificial ventilation is needed
• Upper airway compromise (burns, trauma etc.)
• Unresponsive patient with no gag reflex
• Decreased tidal volume/slow respirations
• Airway obstruction due to foreign bodies, trauma or anaphylaxis

Advantages to intubation
• Seals the trachea
• Facilitates ventilation and O2 because tight face seal is no longer needed
• Prevents gastric insufflation
• Direct route to trachea for suction
• Effective route for some medications: epi, atropine, lidocaine, naloxone

Disadvantages
• Complicated skill using specialized equipment
• Vocal cords must be visualized
• Bypasses warming/filtering/humidifying part of upper airway
• Must be continually reassessed, accidental displacement is common

Contraindications: avoid with epiglottitis

Complications
• Bleeding
• Laryngeal swelling/spasm
• Vocal cord damage
• Mucosal necrosis
• Barotrauma
• Dental trauma
• Misplacement in esophagus or right bronchus

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