ACLS Review

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12 <strong>ACLS</strong> (Advanced Cardiac Life Support) <strong>Review</strong> ... ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ Why is it important not to hyperextend the head of an infant or child when ventilating? Their trachea and necks are very pliable and you may occlude the airway. What special concerns do you have in using the bag-valve-mask device on a pediatric patient? Avoid excessive bag pressure. Use only enough to make the chest rise; more than that can damage the lungs and inflate the stomach. T/F: Gastric distention is more common in adults than in children. False. If you are unable to ventilate a child using the head-tilt, jaw-thrust, or chin-lift, what should you do? Consider an oral or nasal airway. What problems do facial injuries pose to establishing and maintaining a patent airway? Because the blood supply to the face is so rich, blunt injuries to the face frequently result in severe swelling. For the same reason, bleeding into the airway from facial injuries can be a challenge to manage. T/F: Ordinary dentures should always be removed before ventilating a patient. False. What is the concern with partial dentures when ventilating a patient? They may become dislodged and occlude the airway. Identify the following: a leaf-shaped structure that prevents food and liquid from entering the trachea during swallowing. Epiglottis. Identify the following: firm cartilage ring forming at the lower portion of the larynx. Cricoid cartilage. Identify the following: two major branches of the trachea to the lungs. Bronchi. Describe the active process of inhalation. Diaphragm and intercostal muscles contract, increasing the size of the thoracic cavity. Ribs move upward and outward. Air flows into lungs. Describe the process of air exchange at the alveolar/capillary level. Oxygen-rich air enters the alveoli during each inspiration. Oxygen-poor blood in the capillaries passes into the alveoli. Oxygen enters the capillaries as carbon dioxide enters the alveoli.
... CHAPTER 1 Airway Management 13 ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ Describe the normal respiratory pattern. The rate and rhythm is regular, the breathing effort is unlabored, without the use of accessory muscles. Breath sounds are present bilaterally. Chest expansion is adequate and equal. List some signs of inadequate breathing. Rate is outside normal limits for the age of the patient. Breath sounds are diminished or absent. The respiratory effort is increased with use of accessory muscles. The tidal volume may be inadequate or shallow. Nasal flaring may be present. The skin may be pale or cyanotic and cool and clammy. Agonal breathing may be seen just before death. What is the best method for opening an airway? Use the head-tilt, chin-lift when there is no suspicion of neck injury. What are some complications of orotracheal suctioning? Cardiac arrhythmia, hypoxia, coughing, mucosal damage, and bronchospasm. Occasionally you may need to use a technique called the “Sellick maneuver.” Describe this technique and the indications for its use. The “Sellick Maneuver” is slight pressure placed on the cricoid cartilage when intubating a patient. The purpose of the maneuver is to prevent passive regurgitation and aspiration during endotracheal intubation, and it may also aid in visualizing the vocal cords. Where should you look to find the cricoid cartilage? To find the cricoid cartilage, the depression below the thyroid cartilage (Adam’s apple) is palpated. This corresponds to the cricothyroid membrane. What is the purpose of orotracheal intubation? It is the most effective means of controlling a patient’s airway. It is used in apneic patients. It provides good control of the airway and minimizes risk of aspiration. It allows for better oxygen delivery and deeper suctioning. Describe the possible complications that may result from orotracheal intubation. A slowing of the heart rate may occur as a result of stimulating the airway. It may cause damage to the lips, teeth, gums, and airway structures. It may cause vomiting, esophageal intubation, and right main-stem bronchus intubation. Assorted sizes of endotracheal tubes are available for patient use. What size of ET tube should you place in an adult male? 8.0–8.5 mm. Assorted sizes of endotracheal tubes are available for patient use. What size of ET tube should you place in an adult female? 7.0–8.0 mm.
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