Basic Airway Management

Question 1

Principles

Answer 1

There are a number of adjuncts availale for providing airway management. Basic airway management must be established prior to progressing to more invasive procedures

Question 2

Key Points

Answer 2

• Airway management should progress rapidly from the least to most invasive modality
• Never withhold oxygen when there are signs of hypoxia
• Ventilation and oxygenation must be assessed independently

Question 3

Airway Maneuvers - Jaw Thrust - anatomy

Answer 3

The jaw thrust maneuver is recommended for initial airway control as it has been demonstrated to maximally open the airway

The tongue, soft palate and hypopharyngeal tissues all contribute to upper airway obstruction in unconscious humans

Question 4

Airway Maneuvers - Jaw Thrust - mechanical instructions

Answer 4

This “functional obstruction” can be overcome by displacing the tongue anteriorly from the posterior pharyngeal structures as well as displacing the epiglottis anteriorly

The pt’s head should be stabilized in relative alignment with their torso.
The mandible should be displaced anteriorly without extending the pt’s head

Question 5

Airway Maneuvers - Head Tilt Chin Lift

Answer 5

If the jaw thrust does not provide an open airway and there are no contraindications to cervical spine manipulation
the head tilt chin lift can be added

Question 6

Oral Airway - Oropharyngel Airway (OPA)

Answer 6

The OPA is designed to prevent the tongue and other soft tissues from obstructing the glottis.
It is indicated for unresponsive patients who do not have an intact gag relfex

Question 7

OPA - sizing

Answer 7

• Ensure correct size is employed. Measure the OPA from the angle of the jaw to the midline of the mouth
• Also ensure the mouth has been cleared of secretions or debris

Question 8

OPA - insertion methods

Answer 8

• The traditional method is - insert the OPA upside down or at a 90-dgree angle to avoid catching the tongue, then rotating it into proper position after passing the crest of the tongue
• OPA may also be inserted using a tongue depressor to displace the tongue while the device is inserted with the bevel posteriorly over the crest of the tongue

Question 9

OPA - issues

Answer 9

If an OPA becomes plugged with emesis, blood or other secretions, change out the airway

Question 10

OPA - note

Answer 10

Utilization of the OPA does not remove the requirement for manual maneuvers previously described including jaw thrust, positioning the patient and suctioning

Question 11

Nasal Airway - Nasopharyngeal Airway (NPA)

Answer 11

The NPA is used to maintain the airway in a semi-responsive or unresponsive patient w/ or w/o an intact gag reflex

Question 12

NPA - cautions

Answer 12

• patients w/ facial or head trauma - but fear of causing injury in the setting of midface trauma has been overemphasized.
• patients w/ a bleeding disorder or who are on blood thinners, as there can be excessive bleeding compromising the airway
• patients who have had recent nasal and midface surgery

Question 13

NPA - sizing

Answer 13

Measure the NPA from the tip of the nose to the middle of the ear

Also ensure the mouth has been cleared of secretions or debris prior to attempting insertion

Question 14

NPA - insertion

Answer 14

• Lubricate the NPA prior to insertion
• insert the NPA into the nostril that appears the largest, passing it midline along the floor of the nostril following the natural curvature of the nasal passage which lies in an anterior posterior plane.

Question 15

NPA - issues

Answer 15

• A common error with NPA insertion is to attempt to direct it superiorly, aiming upwards, while inserting - this has the potential to cause trauma to the soft tissue of the nasopharynx
• DO NOT FORCE the device; slight rotation of the NPA or use of the opposite nostril may be attempted

Question 16

NPA notes

Answer 16

Utilization of the NPA does not remove the requirement for manual maneuvers previously described including jaw thrust, positioning the patient and suctioning.

Question 17

Bag Valve Mask (BVM) Ventilation

Answer 17

Most patients can be successfully oxygenated and if need be ventilated using good BVM technique
and
adaptinig a staged approach for the Difficult Bag Valve Mask (DBVM) patient

Question 18

BVM - good technique

Answer 18

• well fitting mask
• properly excuted “EC” grip where the index finger and thumb encircle the base of the mask and the middle, ring and small fingers hook the mandible

Question 19

BVM - good mask seal

Answer 19

Key to a successful mask seal is to lift the face into the mask with the EC grip - as opposed to pushing the mask onto the face

“lift and squeeze technique”

Question 20

Difficult Bag Valve Mask - DBVM

Answer 20

the pneumonic “BOOTS” should be considered when predicting those pts whome DBVM techniques may need to be employed

Question 21

BOOTS

Answer 21

B - Beard
O - Old
O - Obese
T - Toothless
S - Sounds

Question 22

DBVM staged approach

Answer 22

• calling for help early
• utilizing two or three person BVM techniques
• changing mask size
• adding OPA and NPA
• extending the head ( assuming no C-spine contraindications
• considering foreign body or cricoid pressure as causing an obstruction
• placement of an extraglottic deivice and/or intubating (if in scope)

Question 23

Positioning

Answer 23

Positioning when the pt does not require ventilatory assistance and there are no other extenuating circumstances
Position the pt 3/4 prone to assist w/ maintaining a clear airway
- Continue to monitor their vital signs and pulse oximetry closely for any sign of respirator embarrassment or change in condition