chapter 7

Chapter 7Basic Airway Control

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Anatomy Review Physiology Personal Protective Equipment Open Assess Suction Secure

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Anatomy Review

Teeth– Trauma can dislodge teeth, causing

a potential airway obstruction– Bleed profusely when disrupted

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Anatomy Review

Lower jawbone is the mandible– Serves as the floor of the mouth– Attached to the mandible is the tongue

Upper jawbone is the maxilla– Holds the roof of the mouth, or the hard palate

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Anatomy Review

Palate is the border between the floor of the nose and the roof of the mouth

Most normal breathing occurs through the nose Nose is responsible for:

– Smelling aromas in the air– Adding moisture to the airway– Raising the temperature of the air to the body

temperature

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Anatomy Review

Pharynx– Area in the back of the throat where the oral cavity

and the nasal cavity meet

Tongue– One of the most important structures in the mouth– Enables us to taste and helps with our speech

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Anatomy Review

Upper lip

Hard palate

Soft palate

Uvula

Lower lip

Pharynx

Tongue

Tonsil

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Anatomy Review

Sublingual area– Medications are often deposited under the tongue to

be absorbed into the bloodstream, due to the rich blood supply found in this area

Esophagus– Tube through which food passes when we swallow

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Anatomy Review

Trachea (windpipe) Epiglottis

– Prevents accidental passage of food into the airway during swallowing

Larynx– Uppermost structure of the lower airway

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Anatomy Review

Hard palate

Tongue

Epiglottis

LarynxEsophagus

Soft palate

Pharynx

Trachea

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Anatomy Review

Gag reflex– Protective response– May lead to vomiting

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Stop and Review

What is the trachea responsible for? What is the esophagus? What is the epiglottis responsible for? Which structure represents the uppermost

portion of the lower airway?

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Physiology

Oxygen is required to allow the cells of the body to produce energy

Lungs supply body with oxygen Lungs get oxygen from the air inhaled

into the airway Airway starts at the mouth and ends in the lungs

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Physiology

If a patient cannot maintain her own airway, the EMT must assist in its maintenance

Movement of air into and out of the lungs is called breathing or ventilation

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Physiology

Signs of an obstructed airway– Unconsciousness– Snoring sound is indicative of a partial obstruction– Breathlessness (apnea)– Blue discoloration (cyanosis)

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Physiology

The tongue is the single most common cause of airway obstruction!

EMTs must quickly recognize the patient with a complete airway obstruction and provide an effective remedy

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Personal Protective Equipment

An EMT protecting the airway is at increased risk of exposure to:– Blood– Sputum– Saliva

In addition to gloves, be sure to wear eye protection and mask

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Open

When assessing a patient, the first question to ask is:– Is the airway open or patent?

The number one priority when assessing the patient is airway, airway, airway!

Without an airway you have no patient; it’s that simple

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Open

Air should move in and out of the mouth and nose without difficulty

Because of the potential for airway blockage or occlusion, EMTs must monitor the airway frequently

If cervical spine injury is suspected, special care must be taken to avoid moving the neck during airway management

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Open

Proper positioning – Unconscious patients found on the ground either face

down or prone must be approached with a high index of suspicion for cervical spinal trauma

– Consider turning patient to the side or the recovery position if no spinal injury is suspected; this facilitates fluid drainage and helps prevent aspiration

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Open

Head tilt, chin lift– The most common airway maneuver used by EMTs is

the head tilt, chin lift • Reserved for patient for whom trauma, specifically

neck injury, has been ruled out• Easily performed by single rescuer

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Head Tilt, Chin Lift

View this video clip demonstrating the head tilt, chin lift maneuver

The animation of this maneuver shows how it opens the airway

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Open

Jaw thrust – If a possible neck injury is suspected or when the

patient’s condition is unknown, the jaw thrust needs to be used• Involves lifting the mandible• Tongue attached to mandible• Lifting the mandible lifts the tongue off the back of the airway

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Jaw Thrust

View this video clip demonstrating the jaw thrust maneuver


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Assess

Any condition that may affect the patency of the airway should be found and addressed– Secretions– Foreign matter– Broken teeth, dental hardware

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Assess

Obstruction– If the airway is obstructed and simple airway

maneuvers such as head tilt, chin lift or jaw thrust do not remedy the problem, consider the possibility of a foreign body airway obstruction

– Follow American Heart Association or American Red Cross guidelines for management of such a condition

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Stop and Review

What is the number one priority when assessing the patient?

Which structure is the most common cause of airway obstruction?

What technique is used to open the airway if a cervical spinal injury is suspected?

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Suction

Unconscious patients cannot clear oral secretions

Every unconscious patient must be suctioned! Don’t forget to take the suction with you

to the call!

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Suction

The suction machine – Manual suction– Electric suction

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Suction

The catheter – Tonsil tip

• Used for saliva or liquid material – Yankauer

• Used to suction thick secretions such as clots– French catheter

• Used to suction external nares, opening of a tracheostomy, and when suctioning through an endotracheal tube

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Suction

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Suction

Suction tubing– Serves as the conduit from the suctioned material to

the machine and from the suction to the patient– Ensure all connections fit tightly so that the suction

machine produces an adequate volume

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Suction

Water– Suction setup should have water available to enable

cleaning of the catheter if it becomes clogged

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Suction

The procedure– Open the airway– Preoxygenate patient– Assemble equipment– Measure catheter– Open mouth using cross-finger technique– Suction no more than 15 seconds

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Suction

Watch this video clip demonstrating suctioning

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Secure

Oropharyngeal airway (OPA)– Designed to keep the tongue off the roof of the

mouth and from falling into the back of the mouth– Creates an artificial channel for the passage

of oxygen into the trachea– Acts as a bite block

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Secure

Oropharyngeal airways (OPAs)– Do not use OPAs with intact gag reflexes– Be alert for possible stimulation of gag reflex

and the potential for vomiting– Be sure to measure and use the right size of OPA;

an improperly measured OPA can actually occlude the airway

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Secure

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Secure

Watch this video clip for demonstration of insertion of the OPA


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Secure

Nasopharyngeal airway (NPA or nasal airway)– Easy to use – Soft, flexible tube that extends from the external

nostril through the nose and into the back of the throat– The NPA does not induce a gag reflex

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Secure

Nasopharyngeal airway (NPA or nasal airway)– Can be used if patient does not tolerate an OPA– NPA does not substitute for manual control of the

airway, and an EMT should maintain either the jaw thrust or the head tilt, chin lift maneuver as needed

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Secure

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Secure

Watch this video clip demonstrating insertion of an NPA

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Stop and Review

Name the three types of catheters commonly used to suction a patient.

What do you need to remember to do before suctioning the patient?

How long should you suction for (maximum seconds)?

Name two devices used as airway adjuncts.

chapter 7

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