Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 12 Airway Management

12-2 Objectives

12-3 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

12-4 The Respiratory System

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

12-12 The Mechanics of Breathing

Special Patient Populations 12-13

12-14 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

12-15 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

Older Adults Cartilage between the sternum and ribs calcifies and stiffens Thoracic cage assumes a barrel- shape 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

12-20 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: I ll (a medical patient) I njured (a trauma patient)

12-21 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

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

12-25 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

12-26 Opening the Mouth Crossed-finger technique

12-27 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

12-28 Jaw Thrust Maneuver Use to open the airway of an unresponsive patient with known or suspected trauma to the head or neck

12-29 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

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

12-40 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

12-41 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

12-46 Suctioning

12-47 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

12-48 Recovery Position

12-49 Keeping the Airway Open: Airway Adjuncts

12-50 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

12-51 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

12-52 Oral Airway Insertion Adult

12-53 Oral Airway Insertion Adult

12-54 Oral Airway Insertion Adult

12-55 Oral Airway Insertion Adult

12-56 Oral Airway Insertion Infant/Child

12-57 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

12-58 Nasal Airway

12-59 Nasal Airway

12-60 Nasal Airway

12-61 Nasal Airway

Questions? 12-62