1. Airway management
If you do not manage the patient’s airway – they will die
Simple MANOEUVRES save lives
© BASICS Education March 2019

2. Objectives: the airway ladder
Surgical Airway
Endotracheal intubation
Supraglotal airway
OPA
NPA
Open Airway, C-spine and O2
MASTER
Suction

3. Airway care Airway obstruction kills Hypoxia kills
Be aware of cervical spine injury potential

4. Airway assessment LOOK for chest and abdominal movement
LISTEN for breathing and abnormal sounds
FEEL for expired air and chest movement

5. Noisy breathing Crowing - laryngeal spasm Gurgling - liquids in airway
Snoring - partial obstruction
A completely obstructed airways makes no noise

6. Oxygen First drug of emergency care Reservoir mask
10 to 15 lpm flow
Reservoir mask
Non - rebreathing mask with reservoir bag
Providing respiratory support:
Pocket mask & O2
BVM with reservoir
BTS guidelines

7. Basic opening manoeuvers
Head tilt / chin lift
Jaw thrust
These manoeuvres lift the tongue off the pharynx and align the axis of the mouth and larynx

8. Suction

9. Nasopharyngeal Airways
Under used & valuable airway management tool
Prevents the soft palate abutting the pharynx
Size 6.0 Female
7.0 Male
Careful use in suspected
basal skull fracture

10. Airway Adjuncts Oropharyngeal airway (OPA) Requires sizing
Centre of teeth to angle of jaw
Corner of mouth to tragus of ear

11. Problems of airway adjuncts
Laryngeal spasm
Local trauma
Raised intracranial pressure
Vomiting

12. Bag-Valve-Masks Always use with a reservoir bag & O2
Difficult to maintain a seal
two person technique
Bagging rate often too high
Squeezing the bag is not the same as ventilation
always look for chest rise
Leaks can result in hypoventilation
Excessive effort inflates the stomach

13. Supraglottic airway – I-Gel / LMA
Blind technique, simple to learn
Highly suitable for pre-hospital use
Better skill retention than ETT
Avoids many problems of face masks
Relatively secure airway
Can leak if seal broken on moving
Sizing
By weight
3 Small adult
4 Female
5 Male

14. Progressing up the airway ladder
Do not move from A to B until A is managed
If an airway method fails:
Revert to last successful method
Reoxygenate
Reassess options
Heading towards extremis – consider:
Surgical crichothyroidotomy

15. Pharmacology and airway control
The routine use of Benzodiazepines to assist airway control is not recommended
RSI is an appropriate method of taking
control of the airway for those who are
qualified and experienced in its use in
The pre-hospital setting
Pre-hospital Anaesthesia
Assoc of anaesthetists of Great Britain & Ireland
Nov 2008

16. Airway management
Questions?

17. SUMMARY Hypoxia kills A always comes before B
Intervene with appropriate adjuncts
Use an airway ladder approach
Stay within your competence & experience

18. Carnival UK Immediate Care Course