Chapter 7
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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

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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

  • 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 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 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 Review


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 Review

  • Trachea (windpipe)

  • Epiglottis

    • Prevents accidental passage of food into the airway during swallowing

  • Larynx

    • Uppermost structure of the lower airway


Anatomy Review


Anatomy Review

  • Gag reflex

    • Protective response

    • May lead to vomiting


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?


Physiology

  • 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


Physiology

  • 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


Physiology

  • Signs of an obstructed airway

    • Unconsciousness

    • Snoring sound is indicative of a partial obstruction

    • Breathlessness (apnea)

    • Blue discoloration (cyanosis)


Physiology

  • 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

  • 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


Open

  • 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


Open

  • 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


Open

  • 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


Open

  • 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

  • View this video clip demonstrating the head tilt, chin lift maneuver

  • The animation of this maneuver shows how it opens the airway


Open

  • 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

  • View this video clip demonstrating the jaw thrust maneuver

  • The animation of this maneuver shows how it opens the airway


Assess

  • Any condition that may affect the patency of the airway should be found and addressed

    • Secretions

    • Foreign matter

    • Broken teeth, dental hardware


Assess

  • 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 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?


Suction

  • Unconscious patients cannot clear oral secretions

  • Every unconscious patient must be suctioned!

  • Don’t forget to take the suction with you to the call!


Suction

  • The suction machine

    • Manual suction

    • Electric suction


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


Suction

  • 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


Suction

  • Water

    • Suction setup should have water available to enable cleaning of the catheter if it becomes clogged


Suction

  • The procedure

    • Open the airway

    • Preoxygenate patient

    • Assemble equipment

    • Measure catheter

    • Open mouth using cross-finger technique

    • Suction no more than 15 seconds


Suction

  • Watch this video clip demonstrating suctioning


Secure

  • 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


Secure

  • 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


Secure


Secure

  • Watch this video clip for demonstration of insertion of the OPA

  • The animation of this maneuver shows how it opens the airway


Secure

  • 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


Secure

  • 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


Secure


Secure

  • Watch this video clip demonstrating insertion of an NPA


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.


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