□ Recognising airway and breathing problems promptly and responding with appropriate interventions will ensure hypoxic damage to vital organs is minimised.
□ Airway obstruction may be partial or complete. The tongue is the most common form of airway obstruction in a patient with a decreased level of consciousness.
□ The best way to recognise any degree of airway obstruction is to assess the patient by looking, listening and feeling.
□ Often the basic airway opening manoeuvres of head tilt, chin lift and jaw thrust will be all that is required to relieve airway obstruction caused by the tongue.
□ Oropharyngeal and nasopharyngeal airways are simple adjuncts that help to prevent backward displacement of the tongue in an unconscious patient.
□ The LMA is an extremely reliable device that can be used during a resuscitation attempt for a patient who has become unconscious and stopped breathing.
□ Assisted ventilation can be achieved by several methods including mouth-to-mouth or nose, mouth-to-mask, bag-valve device attached to facemask, LMA or endotracheal tube or automatic machanical ventilator.
□ Where possible, oxygen should be administered with any ventilation attempts. Failure to do so may compromise chances of survival.
□ The best way to ensure adequate ventilation in the patient is to assess by looking, listening and feeling.
Mrs Betty Booth is a 68-year-old lady who has been admitted to the ward for observation. She has taken an overdose of sedative drugs. Considering her diagnosis, this patient may be at risk for airway and breathing compromise.
Make a list of potential causes of airway and breathing difficulties in such a patient. In addition, discuss how you would recognise any deterioration in Mrs Booth's condition.
• Central nervous system depression following the overdose may result in loss of airway control
• Regurgitation of gastric contents
• Loose dentures
The best way to recognise an airway or breathing problem is to:
• look for signs of a clear airway, level of responsiveness, skin colour and evidence of laboured breathing;
• listen, to determine whether the patient's breathing is noisy, silent or effortless and quiet;
• feel for signs of exhaled air.
Following your assessment of Mrs Booth, you find that she is now difficult to arouse. She is pale and clammy with shallow breathing at a rate of approximately six breaths per minute. You can hear gurgling coming from her airway. How would you respond?
• Open the airway using head tilt and chin lift.
• Use suction to clear the mouth.
• Administer high-flow oxygen via a non-rebreathe oxygen mask.
• Consider inserting an oropharyngeal or nasopharyngeal airway.
• Consider calling the medical emergency team.
Whilst you are managing the situation you recognise that Mrs Booth has become completely unresponsive and has stopped breathing. A pulse check reveals bradycardia at 45 beats per minute. How will you respond to this further deterioration?
Call for appropriate help. If an LMA is immediately available and you are competent in its use then insert it without pre-oxygenation. If the LMA is not an option then begin to ventilate the patient using a mouth-to-mask or bag-valve-mask technique with supplemental oxygen attached. Aim to provide ventilations at a normal respiratory rate (approx 12 breaths per minute). Monitor the effectiveness of ventilations using the look, listen and feel approach. Consider further monitoring, i.e. pulse oximetry and electrocardiogram, to recognise any further deterioration in the circulatory system. Whilst the patient is in respiratory arrest, continue to check the pulse every minute.
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