Upgrade to remove ads
Only $35.99/year

Exam 3 Chapter 10 Airway Obstruction

Terms in this set (12)

Dental hazards
The development of sit-down dentistry has increased the incidence of dental patients aspirating objects into the airway. Examples: tooth fragments, amalgam, gauze, cotton rolls.

The auxiliary should be very assertive with the high volume evacuator and to have cotton plirs to retrieve any dropped objects.

If an object is dropped, remain calm.

Most of the time the gag reflex will allow the patient to cough it up.


Causes and preventons:
- extracted teeth = throat pack
- amalgam = dental dam and suction
- dental dam clamp = ligature placed on clamp
- crowns = throat pack
- impression material = keep patient positioned upright
- broken burs = dental dam
Anatomy of the airway
Most airway obstruction occurs in the upper airway.

Anatomy: the mouth and nose empty into the pharynx (throat) > two passage extend downward > first passage is the trachea (largest passage) & carries air from the pharynx to the lungs > the second passage is the esophagus (behind the trachea) and carries solids and liquids from the mouth to the stomach.

When food is swallowed, it is kept out of the trachea by the epiglottis.

If not, airway obstruction occurs.

Larynx (voice box) completes the upper airway
Types of airway obstructions
Partial airway obstruction: when the airway is not completely blocked & some air gets to the lungs. The patient will cough forcibly. They are able to talk and try to explain that the object "went down the wrong way".
If they do not have adequate air exchange, they are in danger and will not be able to cough. A crowing sound will be made as a result of air passing over the lodged object. With progression, the patient may show signs of cyanosis around the mouth because of the lack of oxygen.

Complete airway obstruction: most life threatening. No noise will be made, the universal distress signal will be made, patient may panic and resist treatment.

Lacking oxygen for 4-6 minutes can result in irreversible brain damage or even death.
Heimlich maneuver
Is a series of manual thrusts that makes use of the air that remains in the victims lungs.

The pressure placed on the abdomen during manual thrusts causes an elevation of the diaphragm, which increases pressure on the lungs and causes an explosive force of air to be released and hopefully to clear the trachea.

Fractured ribs can result
Classifications of Airway Obstructions
Partial obstruction with adequate air exchange: the patient coughs forcibly. The only treatment that should be necessary is encouragement to cough.

Partial obstruction with inadequate air exchange: this patient is in a potentially life threatening situation. Treat as if suffering from complete airway obstruction.

Complete airway obstruction: patient cannot breathe, cannot make any sound, becomes extremely pale and cyanosis , and may die from asphyxiation in approximately 4 to 6 minutes. Treatment: Heimlich maneuver and finger sweeps.
technique
Abdominal thrust - conscious patient
1. Stand behind the patient
2. Wrap your arms around the patient
3. Make a fist with one of your hands
4. Place the thumb of the fist against the patients abdomen halfway between the navel and the rib cage
5. Cover the fist with your other hand
6. Push the fist quickly four times into the abdomen with an inward and upward motion

Abdominal thrust -unconscious patient
1. Place the patient in the supine position
2. Straddle the patient, facing toward the patients head. If the patient is small you may stand or kneel alongside
3. Place the heel of one hand on the patients abdomen
4. Place the other hand on top of the first and interlock the fingers
5. Push the heel of the hand rapidly inward and upward four times into the abdomen

Chest thrust - conscious patient
1. Stand behind the patient
2. Wrap your arms around the patient
3. Make a fist with one hand
4. Place the thumb of the fist against the patients lower sternum. When administering chest thrusts, it is important not to place the hands over the xiphoid process, which could break and cause a laceration of the liver.
5. Place the other hand over the fist
6. Administer four quick thrusts

Chest thrust - unconscious patient
1. Place the patient in the supine position
2. Position yourself either beside or straddling the patient
3. Place the heel of one hand on the patients lower sternum. Make sure not to place the hand on the xiphoid process.
4. Place the other hand on top of the first and interlock the fingers
5. Administer four quick downward chest thrusts

Complete obstruction - conscious patient
1. Stand behind the patient
2. Administer four manual thrusts
3. Repeat until the object is removed or the patient loses consciousness

Complete obstruction- unconscious patient
1. Place the patient in the supine position
2. Open the airway
3. Attempts to ventilate the patient using the mouth to mouth technique
4. If you are unable to get air into the patients lungs, reopen the airway and attempt to ventilate again
5. Administer 4 manual thrusts
6. Make two finger sweeps
7. Repeat the sequence until the object is removed or surgical intervention is performed by trained personnel
Finger sweeps
Performed only on the unconscious patient

1. Open the patients mouth
2. Use the index and middle fingers
3. Place the fingers at the corner of the mouth, and using a hooking motion, sweep across the inside of the mouth to the side
4. Perform two finger sweeps
Heimlich maneuver on infants and children
Choking is the leading cause of death in infants under one year of age.

An infant suffering from complete obstruction does not make any sound, turns pale and cyanosis, and collapses due to asphyxiation.

Treatment

Conscious infant
1. Place the infant supine on your lap or on a firm surface, depending on your own size.
2. Place the tips of your index and middle fingers halfway between the infants naval and rib cage
3. Press inward and upward into the abdomen with four quick movements
4. If the object is not removed after the four manual thrusts, turn the infant onto this stomach with the head lower than the feet and apply four back blows between the shoulder blades
5. Repeat the sequence until the infant recovers or loses consciousness


Unconscious infant
1. Place th infant on your lap or on a hard surface, depending on your own size
2. Open the airway
3. Attempt to ventilate
4. If no response, reopen the airway
5. Attempt to ventilate
6. Place the tips of your index and middle fingers halfway between the infants naval and rib cage
7. Press inward and upward into the abdomen with four quick movements
8. Turn the infant onto the stomach with the head lower than the feet and apply four back blows between the shoulder blades
9. Using the index finger, perform two finger sweeps if the object is visible in the infants mouth
10. Repeat the sequence until the infant recovers or surgical intervention is performed by trained personnel


Heimlich can be performed of 8 years of age
Oral piercing
Can damage

Gingival injury or recession
Damage to teeth or restorations
Interference with speech or chewing and swallowing
Scar tissue formation
Prolonged bleeding
Severe infection
Patients with special requirements
Pregnant
Use chest thrusts

Obese
Lie down or seated
Cricothyrotomy
Incision made through the skin into the trachea to relieve an airway obstruction

Performed as follows
1. Locate the cricothyroid membrane by placing the finger on the Adam's apple and sliding downward toward the feet until you feel a slight indented area
2. Using a sharp object, make a Incisor in this area, and then widen the incision
3. The opening must be maintained. Place an item such as a suction tip or your finger into the incision to keep the airway open.
Performing the Heimlich on yourself
1. Place your hands in the position described for abdominal thrust, and press.
2. Place yourself against the banister of a stairway, corner of a sink, or arm of a chair and press quickly against it. These techniques are by no means as effective as the full Heimlich maneuver but may prove effective when no other means of help is available.
Sets found in the same folder