- Airway management
cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicineand first aid, airway management is the process of ensuring that:
# there is an open pathway between a patient’s
lungs and the outside world, and
# the lungs are safe from aspiration.
In nearly all circumstances airway management is the highest priority for clinical care. This is because if there is no airway, there can be no breathing, hence no oxygenation of blood and therefore circulation (and hence all the other vital body processes) will soon cease. Getting oxygen to the lungs is the first step in almost all clinical treatments. The ‘A’ is for ‘airway’ in the ‘ABC’ of
Head tilt/Chin lift
The simplest way of ensuring an open airway in an unconscious patient is to use a head tilt chin lift technique, thereby lifting the tongue from the back of the throat. This is taught on most
first aidcourses as the standard way of clearing an airway
The jaw thrust is a technique used on patients with a suspected
spinal injuryand is used on a supine patient. The practitioner uses their thumbs to physically push the posterior (back) aspects of the mandible upwards - only possible on a patient with a GCS < 8 (although patients with a GCS higher than this should also be maintaining their own patent airway). When the mandible is displaced forward, it pulls the tongue forward and prevents it from occluding (blocking) the entrance to the trachea, helping to ensure a patent (secure) airway. ILCORno longer advocates use of the jaw thrust by lay rescuers, [ [http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-5 Part 2: Adult Basic Life Support - 112 (22 Supplement): III-5 - Circulation ] ] even for spinal-injured victims, although health care professionals still maintin the technique for specific applications. Instead, lay rescuers are advised to use the same head-tilt for all victims.
Removal of vomit and regurgitation
In the case of a patient who
vomits or has other secretions in the airway, these techniques will not be enough. Suitably trained clinicians may elect to use suction to clean out the airway, although this may not always be possible. A unconscious patient who is regurgitating stomach contents should be turned into the recovery positionwhen there is no suction equipment available, as this allows (to a certain extent) the drainage of fluids out of the mouth instead of down the trachea.
Adjuncts to airway management
There are a variety of artificial airways which can be used to keep a pathway between the lungs and mouth/nose. The most commonly used in long term or critical care situations is the
endotracheal tube, a plastic tube which is inserted through the mouth and into the trachea, often with a cuff which is inflated to seal off the trachea and prevent any vomit being aspirated into the lungs. In some cases. a laryngeal mask airway(LMA) is a suitable alternative to an endotracheal tube, and has the advantage of requiring a lower level of training that an ET tube.
In the case of a choking patient,
laryngoscopyor even bronchoscopymay be performed in order to visualise and remove the blockage.
oropharyngeal airwayor nasopharyngeal airwaycan be used to prevent the tongue from blocking the airway. When these airways are inserted properly, the rescuer does not need to manually open the airway with a head tilt/chin lift or jaw-thrust maneuver. Aspiration of blood, vomitus, and other fluids can still occur with these two adjuncts.
laryngeal mask airway
coauthors = Daniel Limmer, Keith J. Karren, Brent Q. Hafen, John Mackay, Michelle Mackay
title = Emergency Medical Responder (Second Canadian Version)
publisher = Brady
date = 2006
pages = 92-97
isbn = 0-13-127824-X
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