Airway Management Essentials and Techniques

Sep 30, 2024

Take quiz

Review flashcards

Chapter 11: Airway Management

Key Objectives

  • Understand the need for proper airway management
  • Recognize and measure adequate and inadequate breathing
  • Maintain an open airway
  • Provide artificial ventilation
  • Demonstrate use of airway adjuncts, suction equipment, oxygen equipment, CPAP, and resuscitation devices

Importance of Airway Management

  • Address life threats by ensuring adequate breathing
  • Disruption in breathing compromises oxygen delivery

Anatomy of the Respiratory System

Upper Airway

  • Structures: Nose, mouth, oral cavity, pharynx, larynx
  • Functions: Warm, filter, and humidify air
  • Pharynx: Composed of nasopharynx, oropharynx, laryngopharynx
    • Nasopharynx: Filters dust/particles, warms, and humidifies
    • Oropharynx: Prevents food/liquid entering the larynx
  • Larynx: Cartilage structures, marks transition to lower airway
    • Thyroid cartilage: Adam's apple
    • Cricoid cartilage: First ring of the trachea
    • Glottis: Narrowest part of adult airway
    • Vocal cords: Produce speech, protect trachea

Lower Airway

  • Trachea: Air entry to lungs, divides into bronchi
  • Bronchi: Continue into smaller bronchioles, lead to alveoli
  • Alveoli: Site of oxygen/carbon dioxide exchange

Physiology of Breathing

Ventilation, Oxygenation, Respiration

  • Ventilation: Air movement into/out of lungs
  • Inhalation: Active, involves diaphragm/intercostal muscles
  • Exhalation: Passive, diaphragm/intercostal muscles relax

Regulation

  • Breathing is regulated by receptors and feedback loops
  • Hypoxic Drive: Uses oxygen to control breathing

Oxygenation and Respiration

  • Oxygenation: Loading oxygen onto hemoglobin
  • Respiration: Exchange of gases at cellular level

Pathophysiology

  • Ventilation-Perfusion Mismatch: Causes abnormalities in gas exchange
  • Intrinsic Factors: Infections, allergic reactions, unresponsiveness
  • Extrinsic Factors: Trauma, environmental conditions

Patient Assessment

Recognizing Adequate Breathing

  • 12-20 breaths/minute (adults)
  • Regular pattern, equal chest rise

Recognizing Abnormal Breathing

  • Fewer than 12 or more than 20 breaths/minute
  • Irregular rhythm, noisy or diminished breath sounds

Airway Management Techniques

Opening the Airway

  • Head Tilt-Chin Lift: No spinal injury suspected
  • Jaw Thrust: Spinal injury suspected

Suctioning

  • Necessary when hearing gurgling
  • Types: Portable, fixed suction units

Airway Adjuncts

  • Oropharyngeal Airway (OPA): Unresponsive patients without gag reflex
  • Nasopharyngeal Airway (NPA): Semi-conscious with gag reflex

Recovery Position

  • For unconscious, breathing patients to maintain airway

Oxygen Therapy

Equipment

  • Oxygen Cylinders: Compressed gas, labeled, correctly stored
  • Pressure Regulators & Flow Meters: Control gas flow

Safety and Hazards

  • Handle with care, prevent combustion
  • Oxygen Toxicity: Damages tissues, especially in COPD or CVA

Delivery Devices

  • Non-Rebreather Mask: High concentration delivery
  • Nasal Cannula: Mild hypoxia cases

Artificial Ventilation

Methods

  • Bag Valve Mask (BVM): For inadequate breathing
  • Mouth-to-Mask Ventilation: With or without oxygen inlet
  • Positive Pressure Ventilation: Increases intrathoracic pressure

Ventilation Rates

  • Adults: 1 breath every 6 seconds
  • Children/Infants: 1 breath every 2-3 seconds

Complications

  • Gastric Distension: Avoid rapid, forceful ventilations
  • CPAP: Non-invasive support, contraindications include pneumothorax, low BP

Special Considerations

  • Tracheostomy: Ventilate through stoma or trach tube
  • Foreign Body Airway Obstruction: Life-threatening if complete

Assisting with Advanced Procedures

  • Help set up and perform BLS maneuvers during advanced airway interventions
  • Use B MAGIC mnemonic for endotracheal intubation assistance

Study Questions

  1. Breathing is controlled by: Pons and Medulla
  2. Assess tidal volume by observing chest rise and fall
  3. Stimulus to breathe: Increased CO2 levels in blood
  4. Signs of adequate breathing exclude: Shallow chest rise
  5. Vomiting during OPA insertion: Turn patient on side
  6. NPA contraindicated in: Severe head injury
  7. Oxygen nasal cannula discomfort: Use humidified oxygen
  8. Slow, irregular respirations: Bag the patient (assist ventilations)
  9. Notify gastric distension during ventilation: Reposition head

This concludes the review of airway management principles, emphasizing the importance of proper techniques and understanding of respiratory anatomy and physiology.