Airway Management and Respiratory Care

Oct 15, 2024

Airway Management and Respiratory Distress

Basic Respiratory Vital Signs

  • Normal Respirations: 12 to 20 breaths per minute
  • Normal Heart Rate: 60 to 100 bpm
  • Pulse Oximetry (SpO2): 96% to 100%
  • End Tidal CO2: 35-45 mmHg

Respiratory Distress Indicators

  • Breathing rate > 20, heart rate > 100, SpO2 < 96%, ETCO2 > 45: Indicative of respiratory distress.
  • Mild Hypoxia: SpO2 88-94%
  • Moderate Hypoxia: SpO2 84-88%
  • Severe Hypoxia: SpO2 < 84%

Progression of Respiratory Support

  1. Nasal Cannula: 2 to 6 LPM
    • Monitor for improvement: breathing rate, heart rate, SpO2, and ETCO2 moving towards normal.
  2. Non-Rebreather Mask: If nasal cannula is insufficient.
  3. Positive Pressure Ventilation (PPV): If non-rebreather fails.
  4. CPAP Consideration: Between non-rebreather and PPV, before patient becomes too lethargic.

CPAP Indications

  • While patient is alert and can create enough tidal volume.
  • Not suitable if patient is lethargic, unresponsive, or with low blood pressure.

Indicators for RSI and Intubation

  • RSI: Last resort option, if all else fails, and patient is combative or has clenched teeth.
  • Intubation: When patient allows due to lack of consciousness or severe distress.

Considerations for COPD and Hypoxic Drive

  • COPD patients breathe based on low oxygen levels (hypoxic drive), typically maintain 88-94% SpO2.
  • Avoid knocking out hypoxic drive with excessive O2.

Managing Asthma

  • Begin with Albuterol: first treatment solo, second and third combined with Atrovent.
  • Avoid excessive Albuterol without Atrovent to prevent rebound bronchospasm.
  • Consider Epi and Solumedrol for severe cases.

COPD Management

  • Recognize baseline values: higher CO2, mild hypoxia.
  • Adjust oxygen therapy carefully to avoid disrupting hypoxic drive.

Other Conditions

  • Pneumonia: Fluid and Albuterol for young; differentiate from CHF in elderly via vital signs.
  • Epiglottitis vs. Peritonsillar Abscess: Age and symptoms (epiglottitis in children, abscess in adults).
  • Choking/Aspiration: Humidified oxygen and manage based on severity (compressions, object removal).

Airway Equipment Knowledge

  • ET Tube Depth: Tube size x 3 (e.g., 7.0 ET tube = 21 cm depth).
  • Know differences in laryngoscope blades (Miller/Wisconsin vs MacIntosh).
  • Use of Venturi masks for precise oxygen delivery in COPD.

Practice Questions

  • Be prepared for registry questions on drug use in RSI, signs of hypoxia, and airway management protocols.

Key Reminders

  • Always adjust treatment based on continuous monitoring of vital signs.
  • The presence of clear guidelines is essential, but patient assessment and situational context are critical.