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So now I'd like to talk a little more about basic and advanced airways. First let's talk about basic airways. Basic airways are adjuncts which help to direct air and oxygen around natural obstructions in the mouth like the tongue. The Oropharyngeal airway, known as the OPA and a Nasopharyngeal airway called an NPA. The NPA is a basic airway that should be inserted in patients who have a gag reflex and may be semi-conscious. While an OPA is primarily used for those patients who don't have a gag reflex and are unconscious. The correct size of the OPA and NPA are very important in order to not cause further harm or in some cases even block the airway all together. Now a correct way of measuring for the OPA is to connect the tip of the flange to the corner of the patient’s mouth, and the base of the curved plastic to the earlobe area of the patient. Now if for any reason the basic airway is not effective in managing the airway for respirations, an advanced airway should be considered immediately. Now when we talk about advanced airway devices we are primarily talking about endotracheal tubes and laryngeal mask airways. When considering an advanced airway it's important to recognize that this is a procedure that needs a high level of competency to avoid unnecessary injury to the soft tissues and to be able to secure the needed airway in order to properly oxygenate and protect the child patient. Now if a provider feels as though they are not adequately prepared, trained or experienced in the specific needs of the patient’s advanced airway, it is important to select an ALS provider who is comfortable with the proper procedure. When contemplating intubation of a child with upper airway obstruction, we should understand that this is a high risk procedure. And use of a neuromuscular blockade should only be considered if the child can be adequately oxygenated with a simple bag valve mask ventilation system. Next, we’re going to cover the most common ways of delivering oxygen therapy and the levels of oxygenation they each have the potential to produce. For low flow oxygen delivery, one can choose either the nasal cannula or the simple oxygen mask which does not have a rebreather reservoir. The second form is what may be considered high flow oxygenation which includes a nonrebreather mask with reservoir or a high flow nasal cannula. It’s important to remember that several different factors will affect the level of true oxygen therapy to the patient regardless of the delivery mechanism. What is the oxygen flow into the device itself, and what is the ability of the child to inspire the oxygenated air and how well does the device adhere to the child’s face. So now let’s talk about actual percentages of oxygenation delivered with each device. So for the nasal cannula, we can expect a concentration of between 22% and 60% depending on the flow and the ability of the child to inspire the gas. The low flow device will be closer to the 22% while the high flow could be expected to deliver something closer to like the 60% area. The simple oxygen mask delivering low flow oxygen could be expected to deliver between 35% and 60% and oxygen flow rates should be set between 6 liters per minute and 10 liters per minute. Now keep in mind that the simple mask cannot deliver a higher oxygen concentration greater than 60%. To deliver more, we must look to other delivery mechanisms. High flow oxygen systems are much more reliable when it comes to delivering higher oxygen concentrations. A non-rebreather mask is capable of delivering up to 95% oxygen at a flow rate of between 10 and 15 liters per minute. This does depend, however, on how well the mask seals to the patient's face. And it’s important to adjust the oxygen flow rate to keep the reservoir bag inflated and not allow the child’s inspiration effort to collapse the bag as that's gonna effect the oxygen percentage delivered to the patient. A high flow nasal cannula oxygen flow rate can be adjusted from 4 liters all the way up to 40 liters per minute. In fact, the flow can be titrated to provide additional inspiratory and expiratory pressure which may actually help to improve the patient’s workload of trying to breathe. Now one of the most common methods for treating upper airway obstructions like asthma is the use of a nebulizer. This can be used to humidify air in order to help thin secretions or deliver medications such as epinephrine or albuterol. A nebulizer can be used with either a face mask or a T-Pipe style of delivery mechanism. This may depend on the age and the level of consciousness with each patient. A nebulizer should be used with 5 to 6 liters per minute of low flow oxygen in order to appropriately nebulize the solution.
In this lesson, you'll learn about basic and advanced airways, including some common examples of each and things to pay attention to when using them.
Basic airways are adjuncts that help direct air and oxygen around natural obstacles in the mouth, like the tongue. There are two types of basic airways:
Pro Tip #1: The correct size of both OPAs and NPAs are very important in order to not cause further harm to the patient, or in some cases, even block the airway entirely. To measure for an OPA, connect or place the tip of the flange to the side of patient's mouth and the base of the curved plastic to the earlobe area.
Warning: If for any reason, a basic airway isn't effective in managing the airway for respirations, an advanced airway should be considered immediately.
The two most common types of advanced airways are endotracheal tubes and laryngeal masks.
When considering an advanced airway, it's important to recognize that these procedures require a high level of competency to avoid unnecessary injuries to soft tissues and to properly secure the airway in order to effectively oxygenate the patient. If you feel as though you haven't been adequately prepared or don't have enough experience with advanced airway techniques, you should consider getting another PALS provider who is more comfortable and experienced using these procedures.
Pro Tip #2: When considering the intubation of a child with an upper airway obstruction, you should understand that this is a high-risk procedure. Furthermore, use of a neuromuscular blockade should only be considered if the child can be sufficiently oxygenated with bag mask ventilation.
In this section, we'll cover the most common ways to deliver oxygen therapy and the levels of oxygenation that each are capable of producing.
There are several factors that will affect the level of true oxygen therapy delivered to the patient, regardless of the delivery mechanisms, including:
Oxygen percentages of O2 delivered will be different for each device.
When using a nasal cannula, expect a concentration of between 22-60 percent depending on the flow and the ability of the child to inspire the gas.
There are both high flow nasal cannulas and low flow nasal cannulas. A low flow nasal cannula will be close to the low end of that scale above, or 22 percent. While a high flow cannula will be closer to the high end, or 60 percent.
Pro Tip #3: A high flow cannula can be adjusted from 4 liters per minute to 40 liters per minute. It can also be titrated to produce additional inspiratory and expiratory pressure which may help to improve the patient's workload while trying to breathe.
When delivering low flow oxygen, you can expect delivery rates between 35-60 percent. And the oxygen flow rate should be set to between 6 liters per minute and 10 liters per minute.
A simple oxygen mask cannot deliver a high oxygen concentration greater than 60 percent. For greater oxygen delivery, you'll need to use other delivery mechanisms, like high flow oxygen systems, which are much more reliable for delivering higher concentrations.
A non-rebreathing mask is capable of delivering up to 95 percent oxygen at a flow rate between 10-15 liters per minute.
However, this depends on how well the mask seals to the patient's face. It's also important to remember to adjust the oxygen flow rate to keep the reservoir bag inflated, which will affect the oxygen percentage delivered to the patient.
One of the most common methods for treating an upper airway obstruction, like asthma, is with a nebulizer.
A nebulizer can be used to humidify the air in order to help thin secretions or deliver medications, such as epinephrine or albuterol. When using a nebulizer, it should be used in conjunction with 5-6 liters per minute of low flow oxygen in order to appropriately nebulize the solution.
A nebulizer can be used with a face mask or using a tea pipe style delivery mechanism. The delivery system you choose should be dependent on the patient's age and level of consciousness.