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 effect 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 work load of trying to breath.
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.