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Respiratory emergency

BASIC AIRWAY MANAGEMENT TECHNIQUES

1.Opening the Airway

  • Unconcious patient =>Posterior Displacement of Tongue
    • Triple air way manuver
      • head-tilt/chin-lift and jaw-thrust techniques
  • Cervical spine injury best is jaw thrust only no head extension but it still cause spine movement
  • failure in manual intervention use NPPV may help

jaw thrust

place the tips of the middle or index fnigers behind the angle of the mandible,toward the ceiling until the lower incisors are anterior to the upper incisors. alt text

The Head-Tilt/Chin-Lift Maneuver

place the tips of the index and middle fingers beneath the patient’s chin,Lift the chin cephalad and toward the ceiling.neck will extend when the head tilts backward during this maneuver.Apply digital pressure on only the bony prominence,use the thumb to open the patient’s mouth,while the head is tilted and the neck is extended.

2.Postioning patient

  • mimic pt natural position when shortness of breath Supine sniffing position

    • Normal adults => elevating head 10cm , with head tilted back
    • Morbidly obese patients =. use ramp of towels , pillow under upper torso,head and neck head elevation is to achieve horizontal alignment of the external auditory meatus with the sternum.alt text
    • Young pt => without lifting the head because the occiput of a child is relatively large, so the lower cervical spine is normally felxed when the child is lying supine on a flat surface.

  • Cervical injury C/I => Sniffing position

  • Active vomiting/Bleeding => lateral posiiton but difficult airway mng head lift/jaw thrust/chin lift .

Foriegn Body airway aspiration

  • awake partial obstruction
    • clear by own
  • Altered mental status/ no air entry
    • Solid Food in larynx => Concoius patient => Abdominal Thrusts (Heimlich Maneuver) ==> Obstructed food expelled

Heimlich Maneuver

C/I => protuberant abdomens , risk stomach rupture,esophagal perforation, mesentric laceration Sternal hand postion in pregnat patient

  • Loss of Concious patient => Chest Thrusts
  • infants /small children => Back Blows (Slaps) with head down position
  • newborns => Suction
  • Finger sweep => Solid object in mount