Airway Lecture Part 1 (02/01)

Importance of the Airway

Airway management: Crucial in healthcare, without it, nothing else matters.
Body functionality: Airway and pulmonary systems are essential for brain function and overall system health.

Definition: Gas exchange process, different from ventilation (movement of air in and out).
Types:
- External respiration: Moving air into large airways (mouth, nose, trachea).
- Internal respiration: Gas exchange at the terminal ends of the airway (bronchioles to alveoli).
- Cellular level: Oxygen and CO2 exchange at the cellular level.

Definition: Medical intervention to assist breathing.
Minute ventilation: Volume of air moved in and out of lungs per minute (tidal volume x respiratory rate).
Calculation example: For a 6 ft tall male, 9.3 liters of O2 per minute needed.
Effect on cardiac output: Over-ventilation can impede blood return to the heart.

Upper Airway: Mouth to larynx (oral pharynx, nasal pharynx).
Lower Airway: Starts from the larynx down (trachea, bronchi, bronchioles, alveoli).
Diaphragm: Helps in breathing by contracting and relaxing.
Pleura: Visceral (around lungs) and parietal (around chest cavity) with lubricating fluid in between.
Epiglottis: Prevents food from entering the airway during swallowing.
Carina: Point where trachea bifurcates into bronchi.
Alveoli: Site of gas exchange, surrounded by capillaries.

Inhalation: Diaphragm contracts, creating negative pressure, pulling air in.
Exhalation: Passive process, diaphragm relaxes, expelling air.
Sensors and control: Chemoreceptors regulate breathing based on CO2 and O2 levels.

Hypoxia: Lack of oxygen, early signs include restlessness and anxiety, later signs include cyanosis and altered mental status.
Ventilation-Perfusion (VQ) Mismatch: Adequate ventilation but poor gas exchange due to fluid or inflammation.
Conditions: COPD, pneumonia, ARDS, pulmonary embolism, heart failure, etc.

Physical signs: Symmetrical chest rise, skin color, effort of breathing, use of accessory muscles.
Breath sounds: Listen for normal vs abnormal sounds.
Positioning: Look for positions that patients assume to ease breathing (e.g., tripod position).

Suctioning: Essential for clearing airway obstructions; types include Yankauer (rigid) and French (soft) catheters.
Airway adjuncts: Oral and nasal airways to keep the airway open, used based on patient’s level of consciousness and presence of gag reflex.
Oxygen delivery devices: Nasal cannula, non-rebreather masks, Venturi masks, tracheostomy masks, and humidifiers.

Pulse oximetry: Measures oxygen saturation but has limitations (e.g., carbon monoxide poisoning).
Capnography: Measures CO2 at the end of exhalation; useful for monitoring ventilation and perfusion.
Arterial Blood Gases (ABG): Measures pH, CO2, O2, and bicarbonate levels in blood.

Early intervention in respiratory distress: Do not wait to see how bad it gets; intervene early.
Understanding normal vs abnormal: Essential for identifying and correcting issues.
Integration with cardiovascular system: Respiratory and cardiovascular systems work together; issues in one affect the other.

Always have suction ready: Essential for maintaining a clear airway.
Proper use of airway adjuncts: Use correctly sized devices to avoid complications.
Oxygen administration: Adjust based on patient needs; avoid over-oxygenation.
Continuous monitoring: Especially in critical patients or those with advanced airways.

Instructor shared personal experience of losing a family pet, affecting the week's dynamics.

PIN for today's session: 21811