Basic Airway ABDULLAH ALSAKKA EM CONSULTANT

Objectives Review airway anatomy Review basic airway maneuvers

The Upper Airway Epiglottis Mandible Frontal Sinus Soft Palate Trachea Glottis Esophagus Vocal Cords A B C D E F G H

The Upper Airway Other Structures ◦Nasopharynx ◦Oropharynx ◦Hypopharynx ◦Larynx Functions

Functions of the Upper Airway Passageway for air Warm Filter Humidify Protection ◦Gag Reflex ◦Cough Speech

Upper and Lower Airways

The Lower Airway Primary Bronchi Hyoid Bone Right Lung Secondary Bronchi Tracheal Ligament Trachea Larynx Esophagus Left Lung Trachea ABCDEFGHIJABCDEFGHIJ

Airway Anatomy Upper Airway ◦Pharynx ◦Epiglottis ◦Glottis ◦Vocal cords ◦Larynx Lower Airway ◦Trachea ◦Bronchi ◦Alveoli ◦Lung tissue, consisting of lobes and lobules (3 on the right and 2 on the left) ◦Pleura

Airway Anatomy images/CDIMAGE4.JPG arytenoids & aryepiglottic folds

Basic Airway Maneuvers ALWAYS REMEMBER THE BASICS These skills should be used prior to initiating any advanced airway technique ◦Head-tilt/chin lift ◦Jaw thrust ◦Modified jaw thrust (for trauma patients) ◦Sellick’s maneuver

Airway Management Techniques Patency Maneuvers Head tilt with chin lift, or jaw-thrust maneuver

Opening the airway 13

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Jaw thrust technique may be needed if C- spine injury 15

1.Oropharyngeal Airway Size is measured from the corner of the mouth to the angle of the jaw Sizes range from 0-6 It holds the tongue away from the posterior pharynx, but does not isolate the trachea

Simple airway adjuncts R 17

Oral Airway continued The oral airway is inserted with the curve towards the side of the mouth Then rotated so that the curve of the airway matches the curve of the tongue

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Oropharyngeal airway insertion

2.Nasopharyngeal Airway Soft plastic or rubber tube that is designed to pass just inferior to the base of the tongue Passed through one of the nares and can be used in patients with an intact gag reflex CONTRAINDICATED in cases of suspected or possible basilar skull fracture Sizes range from cm in length and 6-9 mm internal diameter Measured from tip of the nose to the corner of the patients ear

Nasal Airway continued The nasal airway is lubricated with a water soluble lubricant The beveled tip is inserted directed towards the septum, with the airway directed perpendicular to the face If resistance is met, rotating the airway may help or the other nare may be used

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Nasopharyngeal airway insertion 24

Bag-Valve-Mask Ventilation  Very important skill to know  May provide temporary or definitive airway management.  One person - importance of a good seal.  Two person technique more effective.  In EMS setting may be as useful as endotracheal intubation.

Bag-Valve-Mask Ventilation