What is the cornerstone of basic airway management?
Bag-mask ventilation
Why is bag-mask ventilation most often needed?
Because of inadequate ventilation
What are causes of inadequate ventilation?
- Impaired respiratory effort
2. Airway obstruction
Impaired respiratory effort can be caused by what?
- Intrinsic factors: intracranial hemorrhage
2. Extrinsic factors: opioid overdose
What are some causes of airway obstruction?
- In an unconscious patient, the tongue may prolapse into the posterior pharynx
- Loss of motor tone in the soft palate
- Obstruction by foreign bodies
- Injured tissue
- Blood
What maneuvers can fix an airway obstruction?
- Head-tilt chin-thrust
2. Jaw-thrust with or without a head tilt
What is the primary maneuver used in a patient in who. Cervical spinal injury is NOT a concern?
Head-tilt chin-lift
Describe the head-tilt maneuver.
- Use both hands to extend the patients neck and open an airway
- While one hand applies pressure to the patients forehead, the tips of the index and middle finger of the second hand lift the mandible at the mentum.
This lifts the tongue from the posterior pharynx
What maneuver is an effective airway technique in patients in whom a cervical spinal injury is a concern?
Jaw-thrust maneuver
Describe the jaw-thrust maneuver.
- By placing the heels of both hands on the parieto-occipital areas on each side of the patients head
- Then grasping the angles of the mandible with the index and ring fingers
- Displacing the jaw anteriorly
What is the purpose of an airway adjunct?
- To prevent the tongue from occlude for the airway
2. Provide an open conduit for air to pass.
When do you use an oropharyngeal airway?
- Should be placed whenever bag-mask ventilation is required.
- Someone who is deeply unresponsive who is unable to maintain their airway.
Does an oropharyngeal airway protect from aspiration of secretions or gastric contacts?
NO!
When do you place an endotracheal tube?
Should be inserted as soon as possible in any patient who is unable to protect his or her airway.
What does an oropharyngeal airway look like?
- Curved
- Firm
- Hollow tube
- Rectangular appetite that is used as a conduit between the mouth and the glottis to prevent obstruction by the tongue
How do you determine the correct Oropharyngeal airway size?
- Hold the airway beside the patients mandible, orienting it with the flange at the patients mouth and the tip directed toward the angle of the mandible
- The tip SHOULD reach the angle of the patients mouth.
What should the clinician avoid when inserting an oropharyngeal airway?
Avoid pushing the tongue into the posterior pharynx.
How do you avoid pushing the tongue into the posterior pharynx when placing an oropharyngeal airway?
- Start with the curve of the OPA INVERTED (pointing up toward you)
- Then rotating it 180 degrees as its tip reaches the posterior pharynx
Describe nasopharyngeal airway.
- Soft rubber or plastic hollow tube
2. Passed through the nose into the posterior pharynx
When is a nasopharyngeal airway used?
Used when an OPA is too difficult, such as when the jaw is clenched or the patient is semi-conscious
What sizes of nasopharyngeal airways should be used for the following:
- Large adult
- Medium adult
- Small adult
- 8-9 cm
- 7-8 cm
- 6-7 cm
How do you determine the correct nasopharyngeal airway size?
Hold the airway beside the patients mandible, orientation it with the flared end at the tip of the patients nose and the distal tip directed toward the angle of the mandible
The tip should just each the angle of the patients mandible
What should be done prior to insertion of a nasopharyngeal airway?
The NPA should be coated with water-soluble lubricant or anesthetic jelly
What does successful bag-mask ventilation depend on?
- A patent airway
- An adequate mask seal
- Proper ventilation
