Chapter 8- Airway Management

A method for (means of) correcting blockage of the airway by moving the jaw forward without tilting the head or neck; this method is indicated when trauma, or injury, is suspected to open the airway without causing further injury to the spinal cord in the neck
Jaw-thrust maneuver
A curved device inserted through the patient’s mouth into the pharynx to help maintain an open airway
Oropharyngeal air-way
An airway that is open and clear and will remain open and clear, without interference to the passage of air into and out of the lungs
Patent airway
Vomiting or retching that may result when something is placed in the back of the pharynx; this is tied to the swallow reflex
Gag reflex
The passageway by which air enters or leaves the body; the structures of the airway are the nose, mouth, pharynx, larynx, trachea, bronchi, bronchioles and alveoli
Airway
A method of correcting blockage of the airway by the tongue by tilting the head back and lifting the chin; this method is indicated when no trauma, or injury, is suspected
Head-tilt, chin-lift
Use of a vacuum device to remove blood, vomitus and other secretions or foreign materials from the airway
Suctioning
A flexible breathing tube inserted through the patient’s nose into the pharynx to help maintain an open airway
Nasopharyngeal air-way
During respiration, the movement of air into and out of the lungs requires that:
air flow be unobstructed and move freely
nasopharynx
where the nasal passages empty into the pharynx
laryngopharynx
structures surrounding the entrance to the trachea
vocal chords
curtain like fibers that line either side of the tracheal opening; not only close shut for protection but also vibrate with the passage of air to create the voice
cricoid ring
1st of 16 cartilaginous rings that protect the trachea
special considerations for children
1) smaller nose and mouth
2) bigger tongue
3) narrower, flexible trachea
4) cricoid cartilage is less rigid and developed
components of suctioning
suction tip, suction catheters, collection container, container of sterile water, tubing
3 rules of suctioning
1) always use appropriate infection control practices
2) suction for no longer than 10 seconds
3) place the tip or catheter where you want to suction and suction on the way out
hoarseness
raspy voice as swelling builds up around vocal chords
snoring
sound of soft tissue of the upper airway creating impedance (or partial obstruction) to the flow of air.
airway obstruction sounds
gurgling, gasping, crowing, wheezing, snoring, and stridor
bronchoconstriction
that contraction of smooth muscle that lines the bronchial passages that results in a decreased internal diameter of the airway and increased resistance to air flow
stridor
a high pitched sound generated from partially obstructed air flow in the upper airway
acute airway obstruction
choking on a foreign body, vomit, blood
obstruction over time
edema from burns, trauma, or infection; decreasing mental status
When a patient inhales, air enters the throat, which is divided into the:
nasopharynx, oropharynx, and laryngopharynx
The hypopharynx is also called the:
laryngopharynx
The large leaf-like structure that protects the opening to the trachea is called the:
epiglottis
When we say that a patient is experiencing lower airway obstruction, it is likely that:
his or her bronchial passages or alveoli are congested
Signs of a potential inadequate airway include what?
absent air movement, unusual hoarse or raspy sound quality in the voice, abnormal noises such as wheezing, crowing, and stridor
An inadequate airway in a child is defined as:
retractions above the clavicles and between and below the ribs
When you question an elderly woman with a respiratory complaint, she speaks in short, two- or three- world sentence. Is this significant?
Yes, she is probably very short of breath
Your patient was the driver of a car that stopped suddenly when she hit a pole. She was not wearing her seatbelt and has a bruise on her neck. When you question her, she speaks very softly and seems to have a raspy voice. Is this significant or just a sign of nervousness about the collision?
Yes, low volume and raspy tone could be due to airway swelling from neck or laryngeal trauma
One indication that a child is experiencing inadequate breathing is that she:
has nasal flaring when breathing
The very first step to aid a patient who is not breathing is to:
administer oxygen
What is the importance of mechanism of injury (MOI) to airway care?
An injury can make airway care easier to manage then a medical emergency
To open the airway of a patient with a suspected head, neck or spine injury, the EMT should use a what maneuver?
jaw-thrust
When performing the head-tilt, chin-lift maneuver, the EMT should:
position himself at the top of the patient’s head
When performing the jaw-thrust maneuver, the EMT should do what?
kneel at the top of the patient’s head, stabilize the patient’s head with forearms, use the index finer to push the angles of the patient’s lower jaw forward
The main purpose of the jaw-thrust maneuver is to:
open the airway without moving the head or neck
An oral or nasal airway should be:
used to keep the tongue from blocking the airway
If something is placed in the patient’s throat, the gag reflex causes the patient to:
vomit or retch
An oropharyngeal airway of proper size extends from the:
corner of the patient’s mouth to the tip of the earlobe
Alveoli
Tiny sacs in grapelike bunches at the end
of the airway
• Surrounded by pulmonary capillaries
• Oxygen and carbon dioxide diffuse through pulmonary capillary membranes
What two questions must be answered when addressed in airway primary assessment?
– Is airway open?
– Will airway stay open?
What are the typical adult sizes in Nasopharyngeal Airway?
34, 32, 30, and 28 French
What is the contraindication to using a nasopharyngeal airway?
evidence of a basilar skull fracture: Battle’s sign, raccoon eyes, cerebrospinal fluid/blood from ears
Most airway problems in adults are caused by this:
the tongue sliding into the airway.
The preferred method of inserting an OPA in a child is by using this
a tongue depressor
If a gurgling sound is heard during artificial ventilation, you should do what?
suction the patient immediately.
this suctioning tip is a rigid device with a larger bore than most catheters, not used with responsive patient’s, but it is possible.
yankauer
If large particles (teeth and solid particles) are found in the mouth, how should you remove them?
using a finger sweep with a gloved finger
Protection of the spine is important in a trauma patient but what takes priority over that?
airway and breathing
A patent airway requires control of the muscles that form the airway. This is referred to as what?
intact muscle tone
The trachea branches at the what and form two main stem bronchi
carina
In an adult patient, an oral airway should be inserted:
upside down, with the tip toward the roof of the mouth, then flipped 180 degrees over the tongue
A nasopharyngeal airway should be:
measured from the patient’s nostril to the earlobe
When inserting a nasopharyngeal airway, lubricate the outside of the tube with:
a water-based lubricant
The purpose of suctioning may include removal of:
blood, vomitus and other secretions
When a patient begins to vomit, it is essential that you have a(n) what ready to go at the patient’s side?
suction unit
You are treating a 29-year-old female who has major airway problems. She has thick secretions and blood in her upper airway that needs to be suctioned with a Yankauer. What is not true of a Yankauer suction tip?
it is used most successfully with responsive patients
airway
the passageway by which air enters or leaves the body.
retractions
pulling in of the muscles when breathing
Suctioning is best delivered with a patient in this position
recovery position
Airway Obstructions
• Acute
– Foreign bodies
– Vomit
– Blood
• Occurring over time
– Edema from burns, trauma, or infection
– Decreasing mental status
• Bronchoconstriction
– Disorder of lower airway
– Smooth muscle constricts internal diameter of airway
Findings Indicating Airway Problems
• Inability to speak
• Unusual raspy quality to voice
• Stridor
• Snoring
• Gurgling
Signs of Inadequate Airway
• Foreign bodies in airway
• No air felt or heard (air exchange below normal)
• Absent or minimal chest movements
• Abdominal breathing
Nasopharyngeal Airway
• Soft, flexible tube inserted through nostril and into hypopharynx
• Moves tongue and soft tissue forward to provide a channel for air
• Can be used in patients with intact gag reflex or clenched jaw
• Contraindicated if clear (cerebrospinal) fluid coming from nose or ears
Suctioning Techniques
• Suction no longer than 10 seconds at a time
• Prolonged suctioning can cause hypoxia and bradycardia
• If patient vomits for longer than 10 seconds, continue suction
The first step of emergency care in the patient with inadequate breathing is:
opening and maintaining the patient’s airway
During your assessment of a 54-year-old male patient, you find that he is not breathing; your next step should be to:
begin providing artificial ventilations to the patient.
Your 24-year-old female patient has fallen from the roof of her house and is unconscious. The best method of opening her airway is the:
jaw-thrust maneuver
Oropharyngeal airways can be used on unconscious patients, except those who:
have a gag reflex.
If you do not have the proper size oropharyngeal airway to fit your patient:
do not use one.
The nasopharyngeal airway is popular because it:
often does not stimulate a gag reflex.
Which of the following is true when suctioning a patient’s airway?
Suction longer than 15 seconds if patient continues to vomit.
The most popular type of suction tip used in the pre-hospital setting is:
rigid pharyngeal tip (Yankauer).
Despite all other patient care delivered, no patient will survive without a(n):
open airway
The EMT’s chief responsibilities are finding and correcting immediately what problems?
life-threatening
The most common impediment to an open airway is the:
tongue
List five steps in determining whether a patient’s airway is adequate.
• Look for adequate and equal expansion of both sides of the chest with inhalation.
• Listen for air entering and leaving the nose, mouth, and chest.
• Feel for air moving out of the nose or mouth.
• Check for typical skin coloration—there should be no blue or gray colorations.
• Note the rate, rhythm, quality, and depth of breathing typical for a person at rest.
List four general procedures to secure an airway.
• Open the airway.
• Insert an airway adjunct.
• Suction the patient.
• Place the patient in recovery position