Patient Assessment: Airway Evaluation Dr SadiaFarhan
Patient Assessment: Airway Evaluation • Quality of care depends on assessment • Adequate breathing • Patient is responsive, alert, able to speak • Rate between 12 and 20 breaths/min • Adequate depth • Regular pattern of inhalation and exhalation • Clear and equal breath sounds • Tendency toward stability in the body • Requires balance between acids and bases • Acid in the body can be expelled as carbon dioxide from the lungs.
Acid-Base Balance • Acidosis can develop if respiratory function is inhibited. • Alkalosis can develop if the respiratory rate is too high. • Respiratory acidosis/alkalosis • Metabolic acidosis/alkalosis
Recognizing Inadequate Breathing • Breathing rate of less than 12 breaths/min or more than 20 breaths/min • Cyanosis: indicator of low blood oxygen • Note the following: • Position • Chest rise/fall • Flared nostrils • Pursed lips • Retractions • Use of accessory muscles • Quick breaths, long exhalation • Labored breathing
Recognizing Inadequate Breathing • Airway management steps: • Open the airway. • Clear the airway. • Assess breathing. • Provide appropriate intervention(s). • Evaluation includes: • Observe • Palpate • Auscultate
Inadequate Breathing • Feel for air movement. • Observe chest for symmetry. • Note any paradoxical motion. • Assess for pulsusparadoxus. • Systolic blood pressure drops more than 10 mm Hg during inhalation.
Inadequate Breathing • Ask about history of present illness • Onset, trigger, duration? • Other symptoms? • Interventions, previous hospitalization? • Medications and overall compliance? • Risk factors?
Protective Airway Reflexes • Evaluate protective reflexes. • Coughing, sneezing, gagging
Assessment of Breath Sounds • Auscultate breath sounds with stethoscope. • Should be clear and equal
Assessment of Breath Sounds • Duration: length of time for inspiratory and expiratory phases • Normal I/E ratio: 1:2 • Expiration is prolonged with lower airway obstruction. • Expiration is short with tachypneic patients.
Assessment of Breath Sounds • Pitch: higher or lower than normal (stridor or wheezing). • Intensity of sound depends on: • Airflow rate • Constancy of flow throughout inspiration • Patient position • Site selected for auscultation
Pulse Oximetry • Pulse oximeter: measures oxygen saturation of hemoglobin (Hb) • Normal: SpO2 of greater than 95%
Pulse Oximetry • Erroneous readings may result from: • Patient motion • Poor perfusion • Nail polish • Venous pulsations • Abnormal hemoglobin
Arterial Blood Gas Analysis • Blood is analyzed for pH, PaO2, HCO3−, base excess, and SaO2. • pH, HCO3−: acid-base status • PaCO2: effectiveness of ventilation • PaO2 and SaO2: oxygenation
End-tidal Carbon Dioxide (ETCO2) Assessment • Detects carbon dioxide in exhaled air • Adjunct for determining ventilation adequacy • Confirms advanced airway placement • ETCO2 detector types: • Digital • Waveform • Digital/waveform • Colorimetric
End-tidal Carbon Dioxide (ETCO2) Assessment • Capnometer • Numeric reading of exhaled CO2 • Capnographer • Graphic representation of exhaled CO2 • Three types: • Waveform • Digital/waveform • Colorimetric
End-tidal Carbon Dioxide (ETCO2) Assessment • Waveform capnography • Exhaled carbon dioxide level displayed as a graphic waveform • Includes contour, baseline level, rate, and rise of carbon dioxide level
End-tidal Carbon Dioxide (ETCO2) Assessment • Waveform capnography(cont’d) • Phase A–B: initial stage of exhalation • Phase B–C: expiratory upslope • Phase C–D: expiratory or alveolar plateau • Phase D–E: inspiratory down stroke
End-tidal Carbon Dioxide (ETCO2) Assessment • Capnography can: • Indicate effectiveness of chest compressions • Detect return of spontaneous circulation • Use is limited with cardiac arrest