Chapter 11: Airway Management

Key Concepts

• Proper airway management is crucial for patient care in emergency situations.
• Recognizing, measuring, and maintaining adequate breathing is essential.
• Use of airway adjuncts, suction equipment, oxygen equipment, and other devices like CPAP and resuscitation devices are fundamental skills.

Anatomy of the Respiratory System

Upper Airway

• Components: Nose, mouth, oral cavity, pharynx, larynx.
• Function: Warms, filters, and humidifies air.
• Pharynx: Muscular tube composed of nasopharynx, oropharynx, and laryngopharynx.
• Larynx: Marks the transition to the lower airway; includes thyroid cartilage (Adam's apple), cricoid cartilage, and vocal cords.

Lower Airway

• Function: Delivers oxygen to alveoli.
• Components: Trachea, bronchi, bronchioles, alveoli.
• Alveoli: Site of gas exchange; surrounded by pulmonary capillaries.

Physiology of Breathing

• Ventilation: Physical movement of air in and out of lungs.
• Inhalation: Active process involving diaphragm and intercostal muscles.
• Exhalation: Passive process where muscles relax.
• Oxygenation: Loading oxygen onto hemoglobin; crucial for internal respiration.
• Respiration: Exchange of gases in alveoli and tissues.

Pathophysiology of Respiration

• Influenced by nervous system through chemoreceptors.
• Ventilation-Perfusion Mismatch: Issue when ventilation or perfusion is compromised.
• Intrinsic/Extrinsic Factors: Include airway obstructions, infections, trauma.

Patient Assessment and Management

Recognizing Adequate Breathing

• Signs: 12-20 breaths/min, regular pattern, clear lung sounds, adequate depth.

Inadequate Breathing

• Signs: Less than 12 or more than 20 breaths/min, irregular rhythm, abnormal sounds.

Assessment Tools

• Pulse Oximetry: Measures oxygen saturation (SpO2 > 94% is ideal).
• End-tidal CO2 Monitoring: Measures CO2 at the end of exhalation.

Opening the Airway

• Techniques:
  • Head Tilt-Chin Lift: For patients without spinal trauma.
  • Jaw-Thrust: For suspected spinal injury.
• Cross-Finger Technique: To open mouth.

Suctioning

• Clear airway to prevent aspiration.
• Use appropriate equipment; do not suction for more than 15 seconds for adults.

Airway Adjuncts

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

Supplemental Oxygen

• Equipment: Oxygen cylinders, regulators, flow meters.
• Safety: Handle carefully; avoid fire.
• Delivery Systems: Non-rebreather masks, nasal cannulas, Venturi masks.

Assisted Ventilation

• Positive Pressure Ventilation: Necessary when patient is not breathing adequately.
• Bag-Valve Mask (BVM): Used for assisted ventilation with correct rate and volume.
• Mouth-to-Mask: Alternative method for ventilation.

Special Considerations

• CPAP: For patients with respiratory distress (e.g., COPD, pulmonary edema).
• Stomas/Tracheostomy: Special techniques for patients with these conditions.
• Foreign Body Airway Obstruction: Use abdominal thrusts for conscious patients.
• Facial Bleeding: Control bleeding and maintain airway.

Assisting Advanced Procedures

• Intubation: EMTs assist by ensuring pre-oxygenation and proper setup.

Review Questions

• Questions and answers at the end of the lecture focus on key concepts like recognizing adequate breathing, appropriate use of airway adjuncts, and safe oxygen delivery.

This chapter provides comprehensive knowledge of airway management critical for emergency care practitioners to ensure proper patient care.