Upper airway obstruction - PowerPoint Presentation

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Upper airway obstruction

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It is one of the most serious emergency situation

Early diagnosis and followed restoration of airflow is essential to prevent cardiac arrest or irreversible brain damage that occurs within minutes of complete airway obstruction

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Causes

Allergic reactions – bee stings, antibiotics or any cause obstruct airway

Chemical burns

Epiglottitis

Foreign bodies

Infections of the upper airway

Injury to the upper airway

Peritonsillar

abscess

Throat cancer

Tarcheomalacia

– weakening of the cartilage that supports trachea

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Symptoms

Agitation

Cyanosis

Changes in consciousness

Chocking

Confusion

Difficulty breathing

Gasping for airPanicUnconsciousness

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Diagnostic measures

Chest and neck radiographs

Laryngoscopy

Computed tomography

Bronchoscopy

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Interventions

Medical interventions

Invasive procedures

Surgical interventions

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Medical interventions

Heimlich maneuver (suspected foreign body aspiration)

Racemic

epinephrine

Helium oxygen mixture

Corticosteroids

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Heimlich maneuver

For a conscious person who is sitting or standing, position behind the person and reach arms around his or her waist.

Place fist, thumb side in, just above the person's umbilicus and grab the fist tightly with other hand.

Pull fist abruptly inward and upward to increase airway pressure behind the obstructing object and force it from the windpipe.

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Racemic

epinephrine

Action - bronchodilator

Indications

Partial UAO with still conscious and able to ventilate

Laryngotracheobronchitis

(croup)

Epiglottitis, laryngeal edemaIt is administered by means of a nebulizer has been proven.

Dose - .5 - .75 ml in 2 ml normal saline (aerosol)

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Corticosteroids

Reducing the airway edema

Treatment of croup

Ex-

dexamethazone

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Heliox

Heliox

, a helium oxygen gas mixture is effective in reducing the work of breathing by decreasing airway resistance.

Post

extubation

laryngeal edema

Tracheal stenosisStatus asthmaticus

oedema

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Invasive procedures

Oropharyngeal

airways

Endotracheal intubation

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Artificial airway management

Airway management

indicated

in patients with loss of consciousness, facial or oral trauma, aspiration, tumor, infection, copious respiratory secretion, respiratory distress and the need for mechanical ventilation.

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Types of airways

Oropharyngeal

airway

– curved plastic device inserted through the mouth and positioned in the posterior pharynx

Usually a short term use in the unconscious patient

Not used after oral surgery, or if loose teeth

Does not protect against aspiration

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Nasopharyngeal airway

(nasal trumpet) – soft rubber or plastic tube inserted through nose into posterior pharynx

Facilitates frequent nasopharyngeal suctioning

Select size that is slightly smaller than diameter of nostril and slightly longer than distance from tip of nose to earlobe

Check nasal mucosa for irritation or ulceration and clean airway with hydrogen peroxide and water.

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laryngeal mask airway

Composed of a tube with a cuffed mask like projection at the distal end

Inserted through the mouth into the pharynx

Seals the larynx and leaves distal opening of tube just above glottis

Easier placement than ET tube because visualization of vocal cords is not necessary

May cause

laryngospasm

and bronchospasm

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Combitube

double – lumen tube

The distal tube enters the esophagus, where the cuff is inflated and ventilation is provided through the proximal tube, which opens at the level of the larynx

In rare instance where the distal tube

intubates

the trachea, ventilation is provided through the distal tube while the proximal tube is clamped.

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ENDOTRACHEAL TUBE

Flexible tube inserted through the mouth and into the trachea beyond the vocal cords that acts as an artificial airway

Maintains a patent airway

Allows for deep tracheal suction and removal of secretions

Permits mechanical ventilation

Inflated balloon seals of trachea so aspiration from the GI tract cannot occur

Generally easy to insert in an emergency, but maintaining placement is more difficult so this is not for long term use

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Surgical interventions

Tracheostomy

Airway

stenting

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A Tracheostomy is a surgical opening in the anterior wall of the trachea to facilitate breathing. The tube enables airflow to enter the trachea and lungs directly, thus bypassing the pharynx and larynx.

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Surgical techniques for the insertion of

tracheostomy

tubes

There are differing surgical techniques for the insertion of Tracheostomy tubes

Cricothyroidotomy

-

Cricothyroidotomy

-is an incision made through the skin and 

cricothyroid

membrane to establish a patent airway during certain life-threatening situations

Percutaneous

tracheostomy

Tracheostomy

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Percutaneous

tracheostomy

Percutaneous

Tracheostomy is an alternative to surgical Tracheostomy and is performed using a guide wire and a process of gradual dilation of the trachea and surrounding tissue. A

tracheostomy

tube is then inserted between the first and second or the second and third tracheal rings.

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Complication of Tracheostomy

 

Immediate (Post Insertion)

Haemorrhage

(minor or severe)

Surgical emphysema

Delayed (Post Insertion)

Tube blockage with secretions. May be sudden or gradual

Infection of the stoma site and bronchial tree

Tracheal ulceration and Tracheal necrosis

Tracheo-oesophageal

fistula formation

Accidental

decannulation

,

Haemorrhage

(minor or severe)

Late (Post

Decannualtion

)

Tracheal dilation

Tracheal

stenosis

at the cuff site

Scar formation

Tracheomalacia

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Tracheostomy tube

Firm, curved artificial airway inserted directly into the trachea at the level of the second or third tracheal ring through surgically made incision

Permits mechanical ventilation and facilitates secretion removal

Can be for long term use

Bypasses upper airway defenses, increasing susceptibility to infection

Allows the patient to eat and swallow

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Tracheostomy tubes consist of three parts

An outer

cannula

with flange (neck plate) – the outer

cannula

is the outer tube that holds the

tracheostomy

open. A neck plate extends from the sides of the outer tube and has holes to attach cloth ties or strap around the neckInner cannula

– it fits inside the outer

cannula

. It has a lock to keep it from being coughed out, and it is removed for cleaning

An

obturator

– is use do insert a

tracheostomy

tube.

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Types of Tracheostomy Tubes

Single Lumen Tubes

Double Lumen Tubes (inner

cannula

)

Uncuffed

Tubes or Cuffed Tubes

Fenestrated Tubes

Metal

tracheostomy

tubes

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Cuffed tubes

It is having cuff ,which is located on the lower part of outer

cannula

which seals and gives ventilation.

Ventilator and other respiratory supportive devices can be attach to it

The cuff blocks any air from flowing around the tube and assures that the patient is well oxygenated.

All the air must therefore flow in and out through the tube itself. A pilot tube attached to the cuff stays outside the body and is used to inflate or deflate the cuff.

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Fenestrated tube

A fenestrated tube has an opening (fenestration) in the back of the outer

cannula

.

The front of the tube can be blocked which allows the air to flow upwards to the upper part of the trachea and larynx.

A fenestrated tube allows the patient to breathe normally and speak or cough through the mouth.

A fenestrated

trach

tube is often used as the final step before

trach

tube removal.

It permits the patient to speak and cough on their own, providing an experimental trial for life after the

trach

tube.

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Cuffless

tubes

Cuffless

tubes are primarily used in non-ventilated patients that have no difficulty swallowing and have no danger of aspiration.

Since there is no cuff, it allows air to pass into the upper trachea and larynx so the patient can cough and speak normally.

Cuffless

tubes are usually worn over a long period of time so require a very accurate fit in order to prevent pressure sores in the trachea or at the tracheal stoma.

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Single lumen and double lumen

tracheostomy

tubes

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Metal

tracheostomy

tube

Indication

Recommendation

Not used as frequently anymore. 

Patients cannot get an MRI.

One needs to notify the security personnel at the airport prior to metal detection screening.

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Pressure monitoring

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The Passy-Muir Valve and open valve

Invented by a patient named David Muir, the Passy-Muir

Tracheostomy & Ventilator Swallowing and Speaking Valve is a simple medical device used by

tracheostomy

and ventilator patients.

The cuff has to be deflated while using valve

When placed on the hub of the

tracheostomy

tube the Passy-Muir Valve redirects air flow through the vocal folds, mouth and nose enabling voice and improved communication.

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Weaning from

tracheostomy

If the patient can adequately exchange air and expectorate secretions, the

tracheosomy

tube can be removed

The stoma is covered with an occlusive dressing

The dressing must be changed if soiled or wetInstruct the patient to splint the stoma with fingers while speaking, swallowing or speaking

The opening will close in several days

Surgical intervention to close the opening is not required

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Nursing diagnosis

Ineffective airway clearance related to presence of

tracheostomy

tube and difficulty expectorating sputum

Interventions

Auscultate

breath sounds

Remove secretions by suctioning to clear airwayEncourage slow deep breathing, turning and coughing to assist in mobilizing secretions

Position to alleviate

dyspnea

– head of the bed elevated 30-40 degree

Provide 100 % humidified oxygen

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Ineffective therapeutic regimen management related to lack of knowledge about care of

tracheostomy

at home

Interventions

Demonstrate skill for the patient

Give clear, step by step instructions

Provide written information

Provide practice sessions

Explain regarding disease condition and the management done – so the patient will get an overall idea for self care

Instruct the patient to watch signs and symptoms and secretions

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Impaired verbal communication related to use of cuffed artificial airway

Interventions

Listen attentively

Use picture board

Provide information to patient about condition

Provide reassurance about patients condition to relive fear and frustration

Provide information to patient regarding different types of

tracheostomy

tubes and speaking valve.

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Risk for infection related to bypass of upper airway defense mechanisms and impaired skin integrity

Interventions

Monitor for systemic and localized signs and symptoms of infection

Monitor complete blood count

Maintain sterile technique when suctioning and providing Tracheostomy care

Provide trachea care every 4 – 8 hours as appropriate – clean the inner

cannula

, clean and dry the area around the stoma and change

tracheostomy

ties.

Inspect the area around the tube insertion site for redness and skin breakdown

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Impaired swallowing related to

tracheostomy

tube

Interventions

Determine patients ability focus attention on learning/performing eating and swallowing tasks

Deflate the cuff before swallowing

Close the stoma site during swallowing

Monitor body weight to determine need for enteral feedings to maintain nutrition