Chapter 6: Airway Management

Cognitive Objectives 2-1.1 Name and label the major structures of the respiratory system on a diagram. 2-1.2 List the signs of inadequate breathing. 2-1.3 Describe the steps in the head-tilt chin-lift. 2-1.4 Relate mechanism of injury to opening the airway. (1 of 5)

Cognitive Objectives 2-1.5 Describe the steps in the jaw thrust. 2-1.6 State the importance of having a suction unit ready for immediate use when providing emergency medical care. 2-1.7 Describe the techniques of suctioning. 2-1.8 Describe how to ventilate a patient with a resuscitation mask or barrier device. (2 of 5)

Cognitive Objectives 2-1.9 Describe how ventilating an infant or child is different from an adult. 2-1.10 List the steps in providing mouth-to-mouth and mouth-to-stoma ventilation. 2-1.11 Describe how to measure and insert an oropharyngeal (oral) airway. 2-1.12 Describe how to measure and insert a nasopharyngeal (nasal) airway. (3 of 5)

Cognitive Objectives 2-1.13 Describe how to clear a foreign body airway obstruction in a responsive adult. 2-1.14 Describe how to clear a foreign body airway obstruction in a responsive child with complete obstruction or partial airway obstruction and poor air exchange. 2-1.15 Describe how to clear a foreign body airway obstruction in a responsive infant with complete obstruction or partial airway obstruction and poor air exchange. (4 of 5)

Cognitive Objectives 2-1.16 Describe how to clear a foreign body airway obstruction in an unresponsive adult. 2-1.17 Describe how to clear a foreign body airway obstruction in an unresponsive child. 2-1.18 Describe how to clear a foreign body airway obstruction in an unresponsive infant. (5 of 5)

Affective Objectives 2-1.19 Explain why basic life support ventilation and airway protective skills take priority over most other basic life support skills. 2-1.20 Demonstrate a caring attitude toward patients with airway problems who request emergency medical services. (1 of 2)

Affective Objectives 2-1.21 Place the interests of the patient with airway problems as the foremost consideration when making any and all patient care decisions. 2-1.22 Communicate with empathy to patients with airway problems, as well as with family members and friends of the patient. (2 of 2)

Psychomotor Objectives 2-1.23 Demonstrate the steps in the head-tilt chin-lift. 2-1.24 Demonstrate the steps in the jaw thrust. 2-1.25 Demonstrate the techniques of suctioning. 2-1.26 Demonstrate the steps in mouth-to-mouth ventilation with body substance isolation (barrier shields). (1 of 4)

Psychomotor Objectives 2-1.27 Demonstrate how to use a resuscitation mask to ventilate a patient. 2-1.28 Demonstrate how to ventilate a patient with a stoma. 2-1.29 Demonstrate how to measure and insert an oropharyngeal (oral) airway. 2-1.30 Demonstrate how to measure and insert a nasopharyngeal (nasal) airway. (2 of 4)

Psychomotor Objectives 2-1.31 Demonstrate how to ventilate infant and child patients. 2-1.32 Demonstrate how to clear a foreign body airway obstruction in a responsive adult. 2-1.33 Demonstrate how to clear a foreign body airway obstruction in a responsive child. 2-1.34 Demonstrate how to clear a foreign body airway obstruction in a responsive infant. (3 of 4)

Psychomotor Objectives 2-1.35 Demonstrate how to clear a foreign body airway obstruction in an unresponsive adult. 2-1.36 Demonstrate how to clear a foreign body airway obstruction in an unresponsive child. 2-1.37 Demonstrate how to clear a foreign body airway obstruction in an unresponsive infant. (4 of 4)

Knowledge and Attitude Objectives Identify the anatomic structures of the respiratory system and state the function of each structure. State the differences in the respiratory systems of infants, children, and adults. Describe the process used to check a patient’s responsiveness. Describe the steps in the head tilt–chin lift technique. (1 of 5)

Knowledge and Attitude Objectives Describe the steps in the jaw-thrust technique. Describe how to check for fluids, solids, and dentures in a patient’s mouth. State the steps needed to clear a patient’s airway using finger sweeps and suction. Describe the steps required to maintain a patient’s airway using the recovery position, oral airways, and nasal airways. (2 of 5)

Knowledge and Attitude Objectives Describe the signs of adequate breathing, the signs of inadequate breathing, the causes of respiratory arrest, and the major signs of respiratory arrest. Describe how to check a patient for the presence of breathing. Describe how to perform rescue breathing using a mouth-to-mask device, a mouth-to-barrier device, and mouth-to-mouth techniques. (3 of 5)

Knowledge and Attitude Objectives Describe, in order, the steps for recognizing respiratory arrest and performing rescue breathing in infants, children, and adults. Describe the differences between the signs and symptoms of a mild airway obstruction and those of a severe or complete airway obstruction. List the steps in managing a foreign-body airway obstruction in infants, children, and adults. (4 of 5)

Knowledge and Attitude Objectives List the special considerations needed to perform rescue breathing in patients with stomas. Describe the special considerations of airway care and rescue breathing in children and infants. Describe the hazards that dental appliances present during the performance of airway skills. Describe the steps in providing airway care to a patient in a vehicle. (5 of 5)

Skill Objectives Demonstrate the head tilt–chin lift and jaw-thrust techniques for opening blocked airways. Check for fluids, solids, and dentures in a patient’s airway. Correct a blocked airway using finger sweeps and suction. Place a patient in the recovery position. Insert oral and nasal airways. (1 of 3)

Skill Objectives Check for the presence of breathing. Perform rescue breathing using a mouth-to-mask device, a mouth-to-barrier device, and mouth-to-mouth techniques. Demonstrate the steps in recognizing respiratory arrest and performing rescue breathing on an adult patient, a child, and an infant. (2 of 3)

Skill Objectives Perform the steps needed to remove a foreign body airway obstruction in an infant, a child, and an adult. Demonstrate rescue breathing on a patient with a stoma. Perform airway management on a patient in a vehicle. (3 of 3)

Airway Management Two most important lifesaving skills: Airway care Rescue breathing To survive, patients need: An open airway Adequate breathing

Anatomy and Function of the Respiratory System All organisms need oxygen to stay alive. The brain can only last 4 to 6 minutes without oxygen. Once brain cells are destroyed, they cannot be replaced. The respiratory system provides oxygen and removes carbon dioxide from cells.

Airway Check for responsiveness. Correct blocked airway. Check for fluids, foreign bodies, or dentures. (1 of 2)

Airway Correct airway using finger sweeps or suction. Maintain airway. (2 of 2)

Correcting the Blocked Airway Head tilt–chin lift technique Jaw-thrust technique

Finger Sweeps Turn patient on side. Insert your finger into patient’s mouth. Curve your finger into a C-shape and sweep from one side of back of mouth to other.

Suctioning Remove any large pieces with gloved hand. Suction only as deep as you can see. Do not suction longer than: 15 seconds at a time for an adult 10 seconds at a time for a child 5 seconds at a time for an infant (1 of 2)

Suctioning (2 of 2)

Maintain the Airway Maintain patient’s airway using one of the following: Recovery position Oral airways Nasal airways

Recovery Position

Oral Airways Used to maintain patient’s airway May only be used on patients without a gag reflex Functions as a pathway to suction patient It is important to select the proper size airway.

Inserting an Oral Airway Select the proper size airway. Open patient’s mouth. Insert airway upside down along roof of mouth. Rotate airway 180 degrees into position.

Nasal Airways Can be used on conscious or unconscious patients Should not be used on patients with head injuries Select proper size airway prior to insertion. Lubricate nasal airway prior to use.

Inserting a Nasal Airway Coat airway with water-soluble lubricant. Select larger nostril. Insert airway until flange rests against nose.

Adequate vs. Inadequate Breathing Rise and fall of chest Sounds of air passing into/out of patient’s nose/mouth Air coming out of nose/mouth Inadequate: Noisy respirations, wheezing, or gurgling Rapid or gasping respirations Pale or bluish skin Respiratory arrest

Correct Breathing Rescue breathing can be performed via: Mouth-to-mask rescue breathing Mouth-to-barrier rescue breathing Mouth-to-mouth rescue breathing

Mouth-to-Mask Rescue Breathing First responder life support kit should contain an artificial respiration device. Mouth-to-mask ventilation device Mask that fits over the patient’s face One-way valve Mouthpiece (1 of 2)

Mouth-to-Mask Rescue Breathing Open airway using head tilt–chin lift technique. Or, open airway using jaw-thrust technique. Seal mask against patient’s face. Breathe through mouthpiece. (2 of 2)

Mouth-to-Barrier Rescue Breathing Small enough to carry in your pocket Place barrier device over patient’s mouth and make a tight seal with your mouth.

Rescue Breathing for Children A child is a person between 1 year of age and the onset of puberty (12 to 14 years). Steps are the same, but differences exist: Do not use as much force to open airways and tilt heads. Rate is slightly faster (one breath every 3 to 5 seconds).

Rescue Breathing for Infants An infant is under 1 year of age. Remember that infants are tiny and fragile! Check for responsiveness by gently shaking the infant’s shoulder.

Foreign Body Airway Obstruction Causes of airway obstruction Tongue Foreign body Vomitus (1 of 2)

Foreign Body Airway Obstruction Types of airway obstruction Mild obstruction Severe obstruction With severe obstructions, patient cannot breathe or speak. (2 of 2)

Removing a Foreign Body Airway Obstruction Look for signs of choking. Stand behind patient. Perform abdominal thrusts.

Airway Obstruction: Unconscious Adult Activate EMS. Open the airway. Check mouth for foreign object and remove if visible. Begin CPR. Continue steps until more advanced EMS personnel arrive.

Airway Obstruction: Children Steps are same as for an adult. Tilt the head just past neutral position. If you are alone and child becomes unresponsive: Perform five cycles of CPR (2 minutes). Activate EMS system.

Airway Obstruction: Infants For conscious infants, perform five back slaps and five chest thrusts. Do not tilt infant’s head back too far.

Special Considerations Patients with stomas Gastric distention Dental appliances Airway management in a vehicle

Gastric Distention Occurs when air is forced into the stomach May cause patient to vomit Breathe just hard enough to make the chest rise.

Airway Management in a Vehicle If patient is lying down, apply jaw thrust. If patient is sitting: Approach from the side. Grasp patient’s head with both hands. Maintain slight upward pressure to support the head and spine. (1 of 2)

Airway Management in a Vehicle (2 of 2)