Question

*paramedicine*

You are called to a 65 year old male, found unconscious in his bed. Nil trauma, nil medical history, NAD on head to toe.

The patient is

GCS 3

HR 100

BP 140/80

RR 4

SPO2 85% RA

BSL 6.0

Temp 36.5

You observe that he is short, approximately 130kgs, has a thick and long beard, has removed his dentures and is snoring.

Discuss difficulties associated with managing this patient’s airway to ensure adequate ventilation. Consider the specific patient information provided.

Discuss what procedures or airway adjunct/s (taught within this unit) you would use on this patient and justify why. Relate this to airway patency and protection.

Response must be researched with a minimum of 5 quality sources with use of intext references.

Answer 1

#. Since the anthropometric measurements reveal that the patient is morbidly obese ,there would be difficulties in airway management of this patient . These include :-

- increased neck , pharyngeal , and occipital tissue leading to difficulty ventilation and intubation

- increased breast tissue interfering with airway instruments

- decreased chest wall compliance , FRC ,and VC, O2consumption ,WOB, all leading to rapid desaturation

- increased abdominal pressure

- Airway resistance is increased (until you increase the FRC with PEEP)

#. Airway adjunts that can be used include :-

- High flow nasal prongs :-

A valid alternative to NIV

Probably better than conventional (unhumidified) oxygen

- NIV:

As effective in obesity as it is in COPD, in terms of CO2 clearance

Higher PEEP is required

Failure is associated with BMI greater than 60

- Intubation and invasive ventilation:

Tidal volumes should be adjusted to ideal body weight

PEEP should be increased (can be up to 20)

Oesophageal manometry is a good guide to help adjust PEEP

Respiratory rate should be increased to accommodate higher metabolic needs (from 12-14 to 18-20).