Airway Management - Chapter 11

Overview

• Focus on understanding proper airway management.
• Recognize and measure adequate/inadequate breathing.
• Maintain an open airway and provide artificial ventilation.
• Demonstrate competency using airway adjuncts, suction, oxygen equipment, CPAP, and resuscitation devices.

Importance of Airway Management

• Critical step in patient care: ensure adequate breathing.
• Disrupted breathing compromises oxygen delivery to tissues.
• Breathing and circulation are key processes for oxygen delivery.

Anatomy of the Respiratory System

Upper Airway

• Structures above vocal cords: nose, mouth, oral cavity, pharynx, and larynx.
• Main functions: warm, filter, and humidify air.
• Pharynx: muscular tube extending from nose/mouth to esophagus/trachea.
  • Nasopharynx: filters dust, warms, and humidifies air.
  • Oropharynx: part of oral cavity; includes epiglottis.
  • Larynx: complex structure; includes thyroid and cricoid cartilages.

Lower Airway

• Function: deliver oxygen to alveoli.
• Trachea: entry to lungs; divides into bronchi and smaller bronchioles.
• Alveoli: site of oxygen and carbon dioxide exchange; surrounded by pulmonary capillaries.

Physiology of Breathing

• Respiratory and cardiovascular systems supply oxygen and remove waste.
• Ventilation: air movement into/out of lungs; includes inhalation and exhalation.
  • Inhalation is active; creates negative pressure allowing air entry.
  • Exhalation is passive; air is expelled due to pressure differences.
• Oxygenation: loading oxygen onto hemoglobin.
  • Can occur without actual respiration (e.g., low environmental oxygen).
• Respiration: exchange of gases in alveoli and tissues.
  • Includes external (pulmonary) and internal respiration (tissue level).

Pathophysiology

• Nervous system factors: chemoreceptors monitor gas levels and regulate breathing.
• Ventilation-perfusion mismatch: causes abnormal gas exchange.
• Intrinsic and extrinsic factors may affect respiratory function (e.g., infections, trauma).

Patient Assessment

• Recognizing adequate breathing: signs include 12-20 breaths/min, clear lung sounds, regular chest rise.
• Abnormal breathing: fewer/more breaths per min, irregular sounds, use of accessory muscles.
• Pulse Oximetry: measures oxygen saturation; normal is >94%.
• End-tidal CO2: measures CO2 at exhalation; normal range is 35-45 mmHg.

Airway Management Techniques

• Opening the Airway: Head-tilt chin-lift (no spinal injury) or jaw-thrust (suspected spinal injury).
• Suctioning: Clear airway using suction devices; avoid prolonged suctioning.
• Airway Adjuncts: Oropharyngeal (OPA) and nasopharyngeal (NPA) airways prevent obstruction.
  • OPA for patients without gag reflex; NPA for gag reflex present.

Supplemental Oxygen

• Administer to hypoxic patients; ensure equipment safety and proper usage.
• Oxygen Cylinders: Check for medical oxygen label and testing dates.
• Pressure Regulators and Flow Meters: Control and measure oxygen delivery.
• Oxygen Delivery Devices: Non-rebreather masks, nasal cannulas, CPAP.

Assisted Ventilation

• Use BVM for patients not breathing adequately.
• Positive Pressure Ventilation: Forces air into lungs; monitor for gastric distension.
• Mouth-to-Mask/BVM Techniques: Ensure proper mask seal and ventilation rate.
• CPAP: Non-invasive support for respiratory distress; contraindications include low blood pressure.

Special Considerations

• Stomas/Tracheostomies: Ventilate through stoma if needed.
• Foreign Body Airway Obstruction: Recognize and manage using abdominal thrusts or CPR.
• Dental Appliances and Facial Bleeding: Manage airway and control bleeding.

Assisting Advanced Life Support

• Collaborate with paramedics; assist in airway management and patient monitoring.

These notes provide a comprehensive overview of airway management as covered in Chapter 11, outlining the anatomy, physiology, patient assessment, and management techniques crucial for emergency care.