Chapter 12
Airway
Management
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12-1
Objectives
12-2
Introduction
• All living cells of the body:
– Require oxygen
– Produce carbon dioxide
• Without oxygen, brain cells
begin to die within 4 to 6
minutes
• A nonbreathing patient or a
patient with difficulty breathing
is a true emergency
12-3
The Respiratory System
12-4
Respiratory System
Functions
• Deliver oxygen-rich blood to body cells
• Transport carbon dioxide from body cells to
the atmosphere
12-5
The Upper Airway
• The nose warms, humidifies, and filters the
air before it enters the lungs
12-6
The Upper Airway
• The mouth is
formed by the
cheeks, lips,
hard palate, and
soft palate
12-7
The Upper Airway
• Pharynx
– Nasopharynx
– Oropharynx
– Laryngopharynx
12-8
The Upper Airway
• Larynx
– Vocal cords
– Thyroid cartilage
– Cricoid cartilage
12-9
The Upper Airway
• Airway obstruction
– Upper airway most common
– Obstruction at or below the vocal cords
will affect the ability to produce sound
12-10
The Lower Airway
• Trachea
• Bronchi
– Carina
• Lungs
– Right lung
• 3 lobes
– Left lung
• 2 lobes
12-11
The Mechanics of Breathing
12-12
Special Patient Populations
12-13
Infant and Child Anatomy
• Epiglottis is large and floppy
• Teeth are absent or very delicate
• Infants younger than 6 months of age
breathe primarily through their nose
• Airway is smaller
– Greater opportunity for obstruction
• Tongue is large compared to size of
mouth
• Trachea is softer and more flexible
12-14
Infant and Child Anatomy
• Narrowest part of a
child’s airway is at the
cricoid cartilage
• Chest wall is flexible
because it is composed
of more cartilage than
bone
• Depend more heavily on
the diaphragm for
breathing
12-15
Older Adults
• Cartilage between the sternum and
ribs calcifies and stiffens
• Thoracic cage assumes a barrelshape
• Diaphragm becomes less elastic
• Muscles of the chest wall weaken
12-16
Older Adults
• Protective reflexes diminish
– Coughing
– Gagging
– Swallowing
• Activity of cilia in the lungs decreases
• Mucus thickens
• Damage or loss of elastic fibers in the small
airways makes them prone to collapse
12-17
Older Adults
• Amount of blood present
in the pulmonary
circulation decreases
• Anatomic dead space
increases
• Thickening of the alveoli
results in fewer alveoli
that participate in gas
exchange
12-18
Airway Assessment
12-19
Airway Assessment
• Perform a primary survey on every patient
– Purpose: Find and care for immediate,
life-threatening problems
• General impression
– Does the patient look “sick” or “not sick”?
– Quickly determine if the patient is:
• Ill (a medical patient)
• Injured (a trauma patient)
12-20
Airway Assessment
• Assess the patient’s level of responsiveness
• Begin by speaking to him to determine:
– Responsive patient
– Unresponsive patient
• Do not move the patient
12-21
Airway Assessment
• Signs of an adequate airway:
– The airway is open and you can hear and
feel air move in and out
– The patient is talking clearly and speaking
in full sentences or crying without
difficulty
– The sound of the voice is normal for the
patient
12-22
Airway Assessment
• Signs of an inadequate airway:
– Unusual sounds are heard with breathing
– Awake patient is unable to speak or voice
sounds hoarse
– No air movement
– Airway obstruction
– Swelling due to trauma or infection
– Snoring
– Secretions in the mouth such as saliva or
blood
12-23
Airway Assessment
• Patent (open) airway
– Talking clearly
– Crying without difficulty
• Complete airway obstruction
– Unable to speak, cry,
cough, or make any other
sound
• Partial airway obstruction
– Noisy breathing
12-24
Opening the Airway
• Unresponsive patient
– Loses ability to keep
airway open
– Tongue falls into the
back of the throat,
blocking the airway
– Moving the jaw
forward lifts the
tongue from the
back of the throat
12-25
Opening the Mouth
• Crossed-finger technique
12-26
Head Tilt–Chin Lift
• Preferred technique
for opening the
airway of an
unresponsive
patient with no
known or suspected
trauma to the head
or neck
12-27
Jaw Thrust Maneuver
• Use to open the airway of an unresponsive
patient with known or suspected trauma to
the head or neck
12-28
Inspecting the Airway
• Look in the mouth:
– Every unresponsive patient
– Any responsive patient who
cannot protect his or her
airway
• Look for an actual or potential
airway obstruction
– Remove foreign body if seen
– Suction airway as needed
12-29
Airway Obstruction
12-30
Foreign Body Airway Obstruction (FBAO)
• Foreign body airway obstruction
– A partial or complete blockage of the
conducting airways due to a foreign body
12-31
Foreign Body Airway Obstruction (FBAO)
• Unresponsive patient
– The tongue is the most common cause of
upper airway obstruction
• Breathing patient
– Snoring respirations = partial obstruction
12-32
Foreign Body Airway Obstruction (FBAO)
• Signs and symptoms of an FBAO depend on
the following:
– The size of the foreign body
– What the foreign body is made of
– Where the foreign body is located
– How long the foreign body has been
present
– If the obstruction produced by the foreign
body is partial or complete
12-33
FBAO
Adults
• Choking in adults is often associated with
the following:
– Attempts to swallow large, poorly chewed
pieces of food
– Alcohol use
– Loose or poorly fitting dentures
12-34
FBAO
Infants and Children
• Common causes of FBAO
– Small foods such as nuts, raisins
– Poorly chewed pieces of meat, grapes, hot
dogs, raw carrots, or sausages
– Items commonly found in the home
12-35
Mild Airway Obstruction
•
•
•
•
Responsive
Able to speak or make sounds
Can cough forcefully
Wheezing may be present between coughs
12-36
Severe Airway Obstruction
• Weak, ineffective cough or may be unable to
cough
• High-pitched noise on inhalation or no
sounds
• Difficulty breathing, speaking or may be
unable to speak
• May turn blue (cyanosis)
12-37
Clearing the Airway
12-38
Manual Maneuvers
• Back slaps
• Abdominal / chest thrusts
• Finger sweeps
12-39
Finger Sweeps
• Used to remove
material from an
unresponsive patient’s
upper airway
• Do not perform on
responsive patients or
on unresponsive
patients who have a
gag reflex
12-40
Suctioning
12-41
Suctioning
• Mounted suction devices
– Built-in on ambulance walls
– Usually powered by the vehicle’s battery
– Provide a vacuum that is strong and
adjustable
– Disadvantages
• Not portable
• Cannot be used with an alternative power
source
12-42
Suctioning
• Battery-operated portable
suction units
– Lightweight and
generally have good
suction power
– Must be checked daily
to make sure it
functions properly
12-43
Suctioning
• Hand-powered devices
– Lightweight
– Portable
– Reliable
– Easy to use
– Relatively inexpensive
12-44
Suction Catheters
• Suction catheters may be rigid or soft.
– Rigid catheters
• Used to quickly suction large amounts of fluid
– Soft catheters
• Used to clear the mouth and throat
• Used by advanced life support personnel to
remove secretions from a tracheal tube in
intubated patients
12-45
Suctioning
12-46
Suctioning
Caution
• Watch your patient closely!
• Heart rate may slow or become
irregular due to:
– Lack of oxygen
– Catheter tip stimulating
back of tongue or throat
12-47
Recovery Position
12-48
Keeping the Airway Open:
Airway Adjuncts
12-49
Airway Adjuncts
• Devices used to help keep airway open
– Airway must first be opened using a
manual maneuver
– Airway adjunct is then inserted
– Proper head position must be maintained
while the device is in place
12-50
Oral Airway
•
•
•
•
Curved device made of rigid plastic
Inserted into patient’s mouth
Keeps tongue away from back of throat
May only be used in unresponsive patients
without a gag reflex
12-51
Oral Airway Insertion
Adult
12-52
Oral Airway Insertion
Adult
12-53
Oral Airway Insertion
Adult
12-54
Oral Airway Insertion
Adult
12-55
Oral Airway Insertion
Infant/Child
12-56
Nasal Airway
• Soft, rubbery tube placed in the nose
• Can be used in unresponsive patients
• Can be used in semi-responsive patients
who have a gag reflex due to:
– Intoxication
– Drug overdose
12-57
Nasal Airway
12-58
Nasal Airway
12-59
Nasal Airway
12-60
Nasal Airway
12-61
Questions?
12-62