i. Choose correct size. With flange at the incisors, tip should reach angle of mandible. If too short, may push tongue back and worsen obstruction; if too long, may cause gagging or reflex laryngospasm or bradycardia through vagal stimulus.
ii. Depress tongue with a tongue blade and insert airway, concave side against tongue, under direct visualization. Have suction ready in case of vomiting.
iii. Assess response and patient tolerance. If improved, airway may be taped in place. If obstruction persists, consider a different size or attempt more definitive airway control.
3. Suctioning. In many cases, upper airway obstruction is related directly to secretions and may be alleviated with suctioning.
a. Types i. Flexible suction catheters. Better for mucus and thin secretions than are tips. Used for NP and artificial airway suction.
ii. Rigid plastic (Yankauer) tips. Better for particulate matter than are catheters. Attached via wide-bore tubing to portable or wall suction units. Wall suction is more powerful, up to -300 mm Hg.
b. Regulation of suctioning. Set at -80 to -120 mm Hg; may be adjusted at the source or by varying occlusion of side port of catheter tip.
c. Intervals of suction. Limit to 20-30 seconds to avoid irritation and potential vagal stimulus.
E. Bag-Mask Ventilation. Indicated when patient is unable to maintain adequate oxygenation or ventilation with spontaneous breathing.
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