Romeo Zab · Transcript · · Updated
EM AP 12 Interventions – Transcript
Video by Romeo Zab · Watch the original on YouTube
Summary
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- Treatment for a partial airway obstruction begins when you recognize it, followed by continual observation because of the threat of total obstruction.
- Placing anything in the patient's airway at this time should be avoided, as even a tongue depressor may cause a partial obstruction to progress to total obstruction.
- Permanent brain injury begins within 4 to 6 minutes after oxygen flow is interrupted during an airway emergency.
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Transcript
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Sean, I want you to bring in emergency-tracking and innovation kit, and I want you to call E&T and anesthesiology, and I'll stay here with Jason. Okay. Do we need to stat that on our next film? That's a good idea, but I don't think we have time. Okay, I'll make those phone calls. Jason, I can tell you're really having a hard time breathing. I think you have a condition called epiglottitis.
Is it bad? Treatment begins when you recognize the partial airway obstruction. After that, continual observation is essential because of the threat of total obstruction. Immediately administer humidified oxygen by mask or nasal cannula for the adult patient.
If the patient is not already sitting upright, raise the head of the stretcher or bed. If possible, use a pulse oximeter to monitor the developing hypoxemia. While these interventions are taking place, immediately notify the anesthesia department and E&T doctor on call.
You'll need an anesthesiologist and surgeon in the event of total airway obstruction if time permits. Also call the operating room to set up an OR for the doctor to intubate and possibly trink the patient under controlled conditions.
Make sure an intravenous access route is established for the administration of emergency drugs, and draw an arterial blood sample to evaluate the PACO2. Don't place anything in the patient's airway at this time.
Just placing a tongue depressor in the mouth, for example, may be all that is required to cause the partial airway obstruction to progress to total airway obstruction. It's best to limit interventions to oxygen administration and monitoring unless anaphylaxis or croup is the underlying cause.
In these situations, subcutaneous epinephrine or nebulized racemic epinephrine administered by mask may be all that's needed to improve the airway obstruction. OR is ready. Let's go.
As a nurse, your responsibilities are considerable when caring for the patient with partial or total airway obstruction. As in many other emergencies, you may not actually perform the interventions, but you can anticipate what will happen next and make it easier for others to intervene.
Let's review some of the important points discussed in this program. Knowing which patients in your care may develop an airway emergency helps you anticipate the need for intervention and have equipment readily available. In many cases, you will be the first person in contact with the patient.
Your ability to recognize the signs and symptoms of both total and partial airway obstruction is essential to the patient's survival. The amount of time you take to restore oxygen flow to the patient's lungs is critical.
Permanent brain injury begins within 4 to 6 minutes after oxygen flow is interrupted. Airway maneuvers used in basic CPR are an integral part of basic airway management. Airway adjuncts, such as nasal and oral airways, must be used to open and maintain the airway.
Monitoring the patient for signs of hypoxemia and hypercarbia not only helps you recognize an impending emergency, but also helps you evaluate the success of intervention. The essence of managing a patient with total or partial airway obstruction is to re-establish the flow of oxygen into the lungs.
Rapid resolution of the problem is critical to the patient's ability to survive. Only a few minutes stand between total recovery and brain death during airway emergencies. Be prepared. Make sure you can recognize the signs and symptoms of an airway emergency.
Know how to monitor the patient closely and intervene appropriately. Taking the time to build and improve your skills now may help you save a patient's life.