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Chapter 7. Basic Airway Control. Overview. Anatomy Review Physiology Personal Protective Equipment Open Assess Suction Secure. Anatomy Review. Teeth Trauma can dislodge teeth, causing a potential airway obstruction Bleed profusely when disrupted. Anatomy Review.

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chapter 7

Chapter 7

Basic Airway Control

  • Anatomy Review
  • Physiology
  • Personal Protective Equipment
  • Open
  • Assess
  • Suction
  • Secure
anatomy review
Anatomy Review
  • Teeth
    • Trauma can dislodge teeth, causing a potential airway obstruction
    • Bleed profusely when disrupted
anatomy review1
Anatomy Review
  • Lower jawbone is the mandible
    • Serves as the floor of the mouth
    • Attached to the mandible is the tongue
  • Upper jawbone is the maxilla
    • Holds the roof of the mouth, or the hard palate
anatomy review2
Anatomy Review
  • Palate is the border between the floor of the nose and the roof of the mouth
  • Most normal breathing occurs through the nose
  • Nose is responsible for:
    • Smelling aromas in the air
    • Adding moisture to the airway
    • Raising the temperature of the air to the body temperature
anatomy review3
Anatomy Review
  • Pharynx
    • Area in the back of the throat where the oral cavity and the nasal cavity meet
  • Tongue
    • One of the most important structures in the mouth
    • Enables us to taste and helps with our speech
anatomy review5
Anatomy Review
  • Sublingual area
    • Medications are often deposited under the tongue to be absorbed into the bloodstream, due to the rich blood supply found in this area
  • Esophagus
    • Tube through which food passes when we swallow
anatomy review6
Anatomy Review
  • Trachea (windpipe)
  • Epiglottis
    • Prevents accidental passage of food into the airway during swallowing
  • Larynx
    • Uppermost structure of the lower airway
anatomy review8
Anatomy Review
  • Gag reflex
    • Protective response
    • May lead to vomiting
stop and review
Stop and Review
  • What is the trachea responsible for?
  • What is the esophagus?
  • What is the epiglottis responsible for?
  • Which structure represents the uppermost portion of the lower airway?
  • Oxygen is required to allow the cells of the body to produce energy
  • Lungs supply body with oxygen
  • Lungs get oxygen from the air inhaled into the airway
  • Airway starts at the mouth and ends in the lungs
  • If a patient cannot maintain her own airway, the EMT must assist in its maintenance
  • Movement of air into and out of the lungs is called breathing or ventilation
  • Signs of an obstructed airway
    • Unconsciousness
    • Snoring sound is indicative of a partial obstruction
    • Breathlessness (apnea)
    • Blue discoloration (cyanosis)
  • The tongue is the single most common cause of airway obstruction!
  • EMTs must quickly recognize the patient with a complete airway obstruction and provide an effective remedy
personal protective equipment
Personal Protective Equipment
  • An EMT protecting the airway is at increased risk of exposure to:
    • Blood
    • Sputum
    • Saliva
  • In addition to gloves, be sure to wear eye protection and mask
  • When assessing a patient, the first question to ask is:
    • Is the airway open or patent?
  • The number one priority when assessing the patient is airway, airway, airway!
  • Without an airway you have no patient; it’s that simple
  • Air should move in and out of the mouth and nose without difficulty
  • Because of the potential for airway blockage or occlusion, EMTs must monitor the airway frequently
  • If cervical spine injury is suspected, special care must be taken to avoid moving the neck during airway management
  • Proper positioning
    • Unconscious patients found on the ground either face down or prone must be approached with a high index of suspicion for cervical spinal trauma
    • Consider turning patient to the side or the recovery position if no spinal injury is suspected; this facilitates fluid drainage and helps prevent aspiration
  • Head tilt, chin lift
    • The most common airway maneuver used by EMTs is the head tilt, chin lift
      • Reserved for patient for whom trauma, specifically neck injury, has been ruled out
      • Easily performed by single rescuer
head tilt chin lift
Head Tilt, Chin Lift
  • View this video clip demonstrating the head tilt, chin lift maneuver
  • The animation of this maneuver shows how it opens the airway
  • Jaw thrust
    • If a possible neck injury is suspected or when the patient’s condition is unknown, the jaw thrust needs to be used
      • Involves lifting the mandible
      • Tongue attached to mandible
      • Lifting the mandible lifts the tongue off the back of the airway
jaw thrust
Jaw Thrust
  • View this video clip demonstrating the jaw thrust maneuver
  • The animation of this maneuver shows how it opens the airway
  • Any condition that may affect the patency of the airway should be found and addressed
    • Secretions
    • Foreign matter
    • Broken teeth, dental hardware
  • Obstruction
    • If the airway is obstructed and simple airway maneuvers such as head tilt, chin lift or jaw thrust do not remedy the problem, consider the possibility of a foreign body airway obstruction
    • Follow American Heart Association or American Red Cross guidelines for management of such a condition
stop and review1
Stop and Review
  • What is the number one priority when assessing the patient?
  • Which structure is the most common cause of airway obstruction?
  • What technique is used to open the airway if a cervical spinal injury is suspected?
  • Unconscious patients cannot clear oral secretions
  • Every unconscious patient must be suctioned!
  • Don’t forget to take the suction with you to the call!
  • The suction machine
    • Manual suction
    • Electric suction
  • The catheter
    • Tonsil tip
      • Used for saliva or liquid material
    • Yankauer
      • Used to suction thick secretions such as clots
    • French catheter
      • Used to suction external nares, opening of a tracheostomy, and when suctioning through an endotracheal tube
  • Suction tubing
    • Serves as the conduit from the suctioned material to the machine and from the suction to the patient
    • Ensure all connections fit tightly so that the suction machine produces an adequate volume
  • Water
    • Suction setup should have water available to enable cleaning of the catheter if it becomes clogged
  • The procedure
    • Open the airway
    • Preoxygenate patient
    • Assemble equipment
    • Measure catheter
    • Open mouth using cross-finger technique
    • Suction no more than 15 seconds
  • Watch this video clip demonstrating suctioning
  • Oropharyngeal airway (OPA)
    • Designed to keep the tongue off the roof of the mouth and from falling into the back of the mouth
    • Creates an artificial channel for the passage of oxygen into the trachea
    • Acts as a bite block
  • Oropharyngeal airways (OPAs)
    • Do not use OPAs with intact gag reflexes
    • Be alert for possible stimulation of gag reflex and the potential for vomiting
    • Be sure to measure and use the right size of OPA; an improperly measured OPA can actually occlude the airway
  • Watch this video clip for demonstration of insertion of the OPA
  • The animation of this maneuver shows how it opens the airway
  • Nasopharyngeal airway (NPA or nasal airway)
    • Easy to use
    • Soft, flexible tube that extends from the external nostril through the nose and into the back of the throat
    • The NPA does not induce a gag reflex
  • Nasopharyngeal airway (NPA or nasal airway)
    • Can be used if patient does not tolerate an OPA
    • NPA does not substitute for manual control of the airway, and an EMT should maintain either the jaw thrust or the head tilt, chin lift maneuver as needed
  • Watch this video clip demonstrating insertion of an NPA
stop and review2
Stop and Review
  • Name the three types of catheters commonly used to suction a patient.
  • What do you need to remember to do before suctioning the patient?
  • How long should you suction for (maximum seconds)?
  • Name two devices used as airway adjuncts.