1 Advanced Airway & Respiratory Assessment & Management Michael D. Gooch, DNP, AC/F/ENP Assistant Professor of Nursing – Vanderbilt Emergency NP – TeamHealth Objectives 1. Exam a patient’s airway to develop the proper course for airway management. 2. Identify common intubation and airways options. 3. Recall the indications and considerations when using medications to facilitate an advanced airway placement. Assessment of the Airway • Is it patent? • Any abnormal sounds? • Is the patient vocalizing? • Is there an obstruction or potential obstruction? – Tongue – Dentures/Teeth – Vomit, Blood – Edema – Foreign bodies Assessment of Breathing • Rate • Quality • Depth • Accessory Muscle Use • Breath Sounds • Chest Wall Integrity • Pulse Oximetry • Capnography • Mental Status Oropharyngeal Airways • Size – measure from the corner of the mouth to the angle of the mandible • Insertion – depress the tongue with a tongue blade or a yankauer and insert over the tongue • Risk of vomiting if the patient still has a gag reflex • May occlude the airway if too large Nasopharyngeal Airways • Size – measure from the nose to the angle of the mandible • Insertion – lubricate, then insert beveled edge against the nasal septum • May stimulate a gag reflex if too large • Contraindications
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Advanced airway management · 1 Advanced Airway & Respiratory Assessment & Management Michael D. Gooch, DNP, AC/F/ENP Assistant Professor of Nursing –Vanderbilt Emergency NP –TeamHealth
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1
Advanced Airway & Respiratory
Assessment & Management
Michael D. Gooch, DNP, AC/F/ENPAssistant Professor of Nursing – Vanderbilt
Emergency NP – TeamHealth
Objectives
1. Exam a patient’s airway to develop the proper course for airway management.
2. Identify common intubation and airways options.
3. Recall the indications and considerations when using medications to facilitate an advanced airway placement.
Assessment of the Airway
• Is it patent?
• Any abnormal sounds?
• Is the patient vocalizing?
• Is there an obstruction or potential obstruction?– Tongue
• Dalley, C. B., Tola, D. H., & Kesten, K. S. (2012). Providing safe passage: Rapid sequence intubation for advanced practice nursing. Advanced Critical Care, 23(3), 270-283. doi:10.1111/aas.12032
• Gooch, M. D. & Roberts, E. (2017). Changing the emergency department’s practice of rapid sequence intubation to reduce the incidence of hypoxia. Advanced Emergency Nursing Journal, 39(4), 266-279. doi:10.1097/TME.0000000000000164
• Holleran, R. S., Wolf, A. C., & Frakes, M. A. (2017). Patient transport: Principles and practice (5th ed). St. Louis, MO: Elsevier.
• Walls, R.M. & Murphy, M.F. (2012). Manual of Emergency Airway Management (4th ed.) Philadelphia: Lippincott Williams and Wilkins.
References
• Weingart, S. D. (2011). Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. The Journal of Emergency Medicine, 40(6), 661-67. doi:10.1016/j.jemermed.2010.02.014
• Weingart, S. D. & Levitan, R. M. (2012). Preoxygenation and prevention of desaturation during emergency airway management. Annals of Emergency Medicine, 59(3), 165-175. doi:10.1016/j.annemergmed.2011.10.002
• Weingart, S. D., Trueger, N. S., Wong, N., Scofi, J., Singh, N., & Rudolph, S. S. (2015). Delayed sequence intubation: A prospective observational study. Annals of Emergency Medicine, 65(4), 350-355. doi:10.1016/j.annemergmed.2014.09.025