Lecture Notes: Airway Management - Emergency Care and Transportation of the Sick and Injured 12th Edition

Overview of Chapter 11

• Understanding the importance of airway management
• Recognizing and measuring adequate and inadequate breathing
• Maintaining an open airway
• Providing artificial ventilation

Anatomy of the Respiratory System

Upper Airway

• Structures: Nose, Mouth, Oral Cavity, Pharynx, Larynx
  • Pharynx: Comprised of nasopharynx, oropharynx, and laryngopharynx
  • Nasopharynx: Filters dust/particles, warms, and humidifies air
  • Oropharynx: Posterior portion of the oral cavity, includes the epiglottis
  • Larynx: Marks division of upper and lower airway
    • Includes thyroid cartilage (Adam’s apple), cricoid cartilage, glottis, and vocal cords

Lower Airway

• Functions to deliver oxygen to alveoli
• Structures: Trachea, bronchi, bronchioles, alveoli
  • Alveoli: Site of oxygen and carbon dioxide exchange

Physiology of Breathing

Processes

• Ventilation: Air movement into and out of the lungs

  • Inhalation: Active process involving diaphragm and intercostal muscles
  • Exhalation: Passive process relaxing diaphragm and intercostal muscles

• Oxygenation: Loading oxygen molecules onto hemoglobin

• Respiration: Exchange of gases (O2, CO2) in alveoli and tissues

  • External: Between alveoli and pulmonary capillaries
  • Internal: Between systemic circulation and cells

Pathophysiology

• Hypoxia: Inadequate oxygenation
• Hypoxic Drive: Control of breathing based on oxygen levels
• Ventilation/Perfusion Mismatch: Disruption can lead to inadequate gas exchange

Airway Management Techniques

Open Airway Techniques

• Head Tilt-Chin Lift: For patients without spinal injury
• Jaw-Thrust Maneuver: For suspected spinal injury

Suctioning

• Portable and fixed suction devices
• Suctioning time limits: 15 sec (adults), 10 sec (children), 5 sec (infants)

Airway Adjuncts

• Oral Airway (OPA): For unresponsive patients without gag reflex
• Nasopharyngeal Airway (NPA): For semi-conscious patients with gag reflex

Positioning

• Recovery Position: For uninjured, unconscious patients with adequate breathing

Supplemental Oxygen and Delivery Systems

Oxygen Equipment

• Oxygen Cylinders: Check labels and dates for safety
• Pressure Regulators and Flow Meters: Control oxygen delivery

Delivery Devices

• Non-rebreather mask: Provides high concentration of oxygen
• Nasal Cannula: For mild hypoxia
• Venturi Mask: Allows precise oxygen concentrations

Safety Considerations

• Avoid creating sparks; ensure proper handling
• Oxygen toxicity: Avoid excessive oxygen use

Assisted and Artificial Ventilation

Techniques

• Mouth-to-mask ventilation
• Bag-Valve Mask (BVM)
  • For patients not breathing but with a pulse

Monitoring and Adjustments

• Ensure proper ventilation rates
• Avoid gastric distention

Advanced Airway Management

• Continuous Positive Airway Pressure (CPAP): For obstructive sleep apnea, pulmonary edema, and COPD
  • Indications and contraindications outlined

Special Considerations

Stomas and Tracheostomy Tubes

• Ventilate through the tube or stoma directly

Foreign Body Airway Obstruction

• Mild Obstruction: Encourage coughing
• Severe Obstruction: Perform abdominal thrusts, chest compressions if unconscious

Dental Appliances and Facial Bleeding

• Manage carefully to prevent airway obstruction

Assisting with Advanced Procedures

• EMT’s role in supporting paramedic procedures

Review Questions

1. Breathing is controlled by the medulla and pons.
2. Assess tidal volume by observing chest rise and fall.
3. Increased CO2 levels stimulate breathing.
4. Inadequate breathing includes shallow chest rise.
5. Begin CPR if patient is unresponsive and not breathing.

These notes capture the main points and essential information from the lecture on airway management, and they are structured to assist in studying and reviewing the chapter effectively.