Respiratory System Airway Management – Techniques and Tools Part V Diana Jones Paramedic

Airway Management You’ve completed your patient assessment and found airway intervention is required. Lets review some techniques and tools of the trade

Airway Management The Basics If you are dealing with a responsive patient, allow them to sit in their position of comfort and provide supplemental oxygen as needed. It may be all that is required. If your patient is unresponsive and you must open their airway Head-tilt, chin-lift Jaw thrust

Airway Management The Tools Nasopharyngeal Airway (NPA) Oropharyngeal Airway (OPA) Nasal Cannula Non-rebreather Bag-valve mask Endotracheal tube Rescue device (King Airway) Suction equipment

The Tools NPA Nasopharyngeal Airway- NPA, nose hose, nasal trumpet Measured in French catheter size Sizing done by measuring from tip of nose to earlobe or angle of jaw Lubricate generously and insert with bevel toward septum Contraindicated in head or facial trauma- the brain needs oxygen, just not directly

The Tools OPA Oropharyngeal Airway- OPA Variety of sizes Sizing done by measuring from corner of the mouth to angle of the jaw Insert upside down by sliding along hard palate then turning once you reach soft palate Insert using a tongue depressor Contraindicated in presence of gag reflex

The Tools OPA

The Tools Supplemental oxygen can be delivered through a variety of devices Nasal Cannula Non-rebreather For every 1 liter of flow, oxygen concentration is increased by 4% - What does this mean? Atmospheric oxygen concentration is 21% 1 liter flow adds 4%, so you have increased oxygen concentration to 25% 6 liter flow adds 24%, so you have increased oxygen concentration to 45%

The Tools BVM Bag-valve Mask Used to manually assist ventilations Patient may be apneic or have inadequate respirations Mask covers nose and mouth forming a tight seal or connected to endotracheal tube Bag is squeezed until adequate chest rise and fall

The Tools ETT Endotracheal Tube Come in a variety of sizes Most commonly placed through oral cavity but can be placed through the nose Must be very diligent in verifying correct placement Intubation to be covered in more detail in different presentation

The Tools Suctioning Used to clear the airway of debris whether blood, vomit, mucus, or foreign object Can be performed using rigid or soft catheter Both have specific uses Insert with suction off, only suction on the way out Limit suction to 15 seconds before providing additional ventilation

The Tools King Airway King airways are commonly referred to as rescue devices Blind placement, meaning the vocal cords do not have to be visualized Can be placed by basic personnel Used to secure airway when intubation is not allowed by level of provider or when intubation is unsuccessful Comes in a variety of sizes and choice is made based on patient height

The Tools King Airway *New evidence is emerging that these devices may not be ideal during cardiac arrest. There is support that blood flow through the large vessels of the neck (carotid) is reduced. If the point of compressions is to perfuse the patient then wouldn’t the King be counter-productive?* Just food for thought…..always follow your protocol!

Questions?