airway management – NurseCheung.com https://nursecheung.com From "You're Not Good Enough" To "Look At Me Now!" Wed, 06 Dec 2023 15:09:25 +0000 en-US hourly 1 https://wordpress.org/?v=6.4.3 https://2hya11.p3cdn1.secureserver.net/wp-content/uploads/2023/01/nurse-cheung-logo-Logo-1000-×-1000-px-2-150x150.png airway management – NurseCheung.com https://nursecheung.com 32 32 Out-Of-Hospital ACLS Airway Management Megacode: The Best Strategies for Saving Lives https://nursecheung.com/aclsmegacode-ooh-airwaymanagement/ Sat, 07 Jan 2023 17:14:33 +0000 https://nursecheung.com/out-of-hospital-acls-airway-management-megacode-the-best-strategies-for-saving-lives/

Table of Contents

Adult Out-Of-Hospital Respiratory Arrest Megacode Scenario

The following is a scenario in which you would use the out-of-hospital adult respiratory arrest Megacode:

You are a paramedic and arrive on the scene for a woman having an asthma attack at home.

Demonstrate what you would do next

Initial Impression

The woman is conscious and reports difficulty breathing during her evening meal. The woman begins to have respiratory distress and a decrease in mental status.

Primary Assessment Survey (A, B, C, D, E)

Airway: The airway is starting to swell. The flow through the trachea is impaired.

Breathing: Oxygenation is showing less than 50% on room air. Agonal gasps are noted.

Circulation: Blood pressure is 60/38, heart rate is 120/min, and the pulse is present but weak.

Disability: Decrease in mental status. Responsive to verbal stimulation.

Exposure: No obvious signs of trauma, bleeding, burns, markings, or medical alert bracelet.

Change in Condition

After assessment of the initial impression and primary assessment, the woman becomes unresponsive.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” There is no response.
  2. Activate the emergency response system. You direct the second rescuer to activate the emergency response system and get an AED.
  3. Check for breathing: Look for visible chest rising and falling. No breathing present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but weak.
 

What are your next actions?

  1. Pulse is present so we will not begin CPR starting with compressions.
  2. The decision between oropharyngeal or nasopharyngeal airway can be difficult, but there are a few things to consider when making the decision.
  3. Oropharyngeal airways are inserted into the mouth, and nasopharyngeal airways are inserted into the nose. Oropharyngeal airways are more likely to be successful the first time, but nasopharyngeal airways are less likely to cause vomiting.
  4. Administer oxygen. Oxygen saturation is less than 50%. 
  5. Perform bag-mask ventilation for 1 minute effectively at the proper rate (1 breath every 6 seconds), speed (over 1 second), and volume (about half a bag).
 

The woman is stable and oxygen saturation is rising. What are your next steps?

Secondary Survey (SAMPLE)

Signs and Symptoms: Signs and symptoms are improving; however, swelling is still present.

Allergies: The woman’s friend states she has an allergy to peanuts.

Medications: Albuterol inhaler and an epinephrine pen

Past Medical History: Asthma

Last Meal, Liquid Consumed: Last meal and liquid consumed during the asthma attack. This ordered Chinese takeout Pai Thai.

Events: No events lead up to the asthma attack.

What are your text interventions?

  • Epinephrine
  • Diphenhydramine
  • Albuterol
  • Vital signs monitoring
  • Monitor for any changes
 
 

You will begin the transfer to the nearest hospital. Your scenario has concluded.

]]> Emergency Department ACLS Airway Management Megacode: The Best Strategies for Saving Lives https://nursecheung.com/aclsmegacode-ed-airwaymanagement/ Sat, 07 Jan 2023 17:14:31 +0000 https://nursecheung.com/emergency-department-acls-airway-management-megacode-the-best-strategies-for-saving-lives/

The Airway Management section of the AHA Emergency Department (ED) ACLS algorithm is one of the most important, and it can be difficult to know what to do when someone is choking or has another airway emergency.

We will provide you with a step-by-step guide on how to manage an airway emergency, as well as some tips for avoiding common mistakes.

In this blog post, we will discuss the best strategies for saving lives in the Emergency Department setting.

Adult ED Respiratory Arrest Megacode Scenario

The following is a scenario in which you would use the ED adult respiratory arrest Megacode:

You are working the day shift in an emergency department. You are asked to see a new patient in your bay. A bystander called 911 after finding a man unconscious in a ditch.

Demonstrate what you would do next

Initial Impression

The man is unconscious with mildly cyanotic lips. The paramedics placed a nasopharyngeal airway and have been trying to ventilate but have had difficulty. The paramedics also noted that there were drug paraphernalia on the scene and an empty syringe.

Primary Assessment Survey (A, B, C, D, E)

Airway: There is a nasopharyngeal airway present. It is being ventilated by paramedics on arrival and taken over by respiratory. The flow through the trachea is impaired by the tongue.

Breathing: Oxygenation is showing 75% with bag valve mask ventilation. The man has no spontaneous breaths.

Circulation: Blood pressure is 100/60, heart rate is 140/min, the rhythm is narrow-complex rapid tachycardia, and the pulse is present but weak.

Disability: Unresponsive to any stimuli. Pupils are dilated bilaterally at 7 mm (commonly misused drugs that dilate pupils are amphetamines, bath salts, benzodiazepines, cocaine, crystal meth, ecstasy, LSD)

Exposure: Numerous track marks are located on the man’s arms.

Change in Condition

After assessment of the initial impression and primary assessment, the man’s oxygen continues to decline and his heart rate increases.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” Found unresponsive during the primary survey, move on to the next step.
  2. Activate the emergency response system. Shout for backup and announce what room you are in.
  3. Check for breathing: Look for visible chest rising and falling. No spontaneous breathing was present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but weak.
 

What are your next actions?

  1. Pulse is present so we will not begin CPR starting with compressions.
  2. The nasopharyngeal airway is not working effectively. It may be time to switch to endotracheal intubation.
  3. Administer oxygen. After endotracheal intubation, the oxygen saturation is 99% with positive color changes on the CO2 Detector. Waveform capnography is the gold standard.
  4. Perform bag-mask ventilation for 1 minute effectively at the proper rate (1 breath every 6 seconds), speed (over 1 second), and volume (about half a bag) until the ventilator arrives.
 

The man is stable and oxygen saturation is normal. What are your next steps?

Secondary Survey (SAMPLE)

Signs and Symptoms: Signs and symptoms are improving, heart rate has decreased to 90 bpm normal sinus rhythm; however, no spontaneous breathing is noted.

Allergies: Unknown if there are any allergies.

Medications: Unknown if there are any medications.

Past Medical History: Unknown if there is any past medical history.

Last Meal, Liquid Consumed: Unknown when the last meal and liquid were consumed.

Events: No events were noted outside of what was discussed with the paramedic team.

What are your text interventions?

  • Drug urinalysis
  • Labs
  • Fluids
  • Naloxone trial with escalating doses
  • Transfer to a higher level of care – Intensive Care Unit
 
 

You will begin the transfer to the unit. Your scenario has concluded.

]]> Inpatient ACLS Airway Management Megacode: The Best Strategies for Saving Lives https://nursecheung.com/aclsmegacode-ip-airwaymanagement/ Sat, 07 Jan 2023 17:14:29 +0000 https://nursecheung.com/inpatient-acls-airway-management-megacode-the-best-strategies-for-saving-lives/

The Airway Management section of the AHA Inpatient ACLS algorithm is one of the most important, and it can be difficult to know what to do when someone is choking or has another airway emergency.

We will provide you with a step-by-step guide on how to manage an airway emergency, as well as some tips for avoiding common mistakes.

In this blog post, we will discuss the best strategies for saving lives in the inpatient setting.

Adult Inpatient Respiratory Arrest Megacode Scenario

The following is a scenario in which you would use the inpatient adult respiratory arrest Megacode:

You are the healthcare provider taking care of a female patient with a history of diabetes in the intermediate care unit. The patient is noncompliant with medications for her asthma and heart failure and is well known by the cardiologist and pulmonologist. She has been intubated and sedated prior to coming to you.

Demonstrate what you would do next

Initial Impression

The woman is currently on CPAP at 10 as part of her heart failure treatment. She is becoming restless, short of breath, and trying to take the mask off.

Primary Assessment Survey (A, B, C, D, E)

Airway: There is a CPAP mask present. It is hard to determine if the woman’s airway is patent due to her restlessness and combativeness.

Breathing: Oxygen saturation is showing 80% with CPAP 100% oxygen. Respiratory rate is 28/min. The patient states “I can’t keep this up much longer.” Breath sounds are diminished bilaterally. Wheezing and crackles are noted upon auscultation.

Circulation: Blood pressure is 128/90, heart rate is 82/min, and the pulse is present but weak. Capillary refill is 3 seconds.

Disability: The woman is alert, oriented, and restless. She is attempting to remove the CPAP mask and eventually takes it off.

Exposure: Skin is cool to the touch.

Change in Condition

After assessment of the initial impression and primary assessment, the woman becomes unresponsive while attempting to place the mask back on and waiting for respiratory therapy/rapid response.

What are your next actions?

  1. Check responsiveness: Tap the shoulders and shout, “Are you okay?” The woman is unresponsive and doesn’t answer any stimuli.
  2. Activate the emergency response system. Shout for backup and announce what room you are in. It is perfectly acceptable to hit the code button for faster backup.
  3. Check for breathing: Look for visible chest rising and falling. No spontaneous breathing was present.
  4. Check for a pulse: Place your fingers on the inside of the patient’s neck, just below the angle of the jaw. You will palpate the carotid pulse for no more than 10 seconds. Pulse is present but weak.
 

What are your next actions?

  1. Pulse is present so we will not begin CPR starting with compressions.
  2. Start providing oxygenation via bag valve mask with oxygen while waiting for help to arrive. Perform bag-mask ventilation for 1 minute effectively at the proper rate (1 breath every 6 seconds), speed (over 1 second), and volume (about half a bag) until the ventilator arrives.
  3. Consider endotracheal re-intubation due to condition deterioration. After endotracheal intubation, the oxygen saturation is 99% with positive color changes on the CO2 Detector. Waveform capnography is the gold standard.
 

The woman is stable, restless, and oxygen saturation is within normal but falling slowly due to her biting on the tube. What are your next steps?

Secondary Survey (SAMPLE)

Signs and Symptoms: Signs and symptoms are improving; however, no spontaneous breathing is noted.

Allergies: Allergic to morphine and acetaminophen

Medications: Albuterol, Metformin, and digoxin

Past Medical History: Diabetes, asthma, and congestive heart failure

Last Meal, Liquid Consumed: Unknown when the last meal and liquid were consumed as she was transferred to your unit without a full report.

Events: No events were noted outside of what was discussed.

What are your text interventions?

  • Albuterol
  • Sedation for restlessness
  • Arterial Blood Gases
  • Maybe Fluid – Depends on the Heart Failure
  • Waveform Capnography
  • Critical Care Consult
  • Transfer back to a higher level of care – Intensive Care Unit
 
 

You will begin the transfer to the unit. Your scenario has concluded.

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