Chapter 7 Basic Airway Control

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Anatomy Review  Physiology  Personal Protective Equipment  Open  Assess  Suction  Secure

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Anatomy Review  Teeth –Trauma can dislodge teeth, causing a potential airway obstruction –Bleed profusely when disrupted

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Anatomy Review

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Anatomy Review  Trachea (windpipe)  Epiglottis –Prevents accidental passage of food into the airway during swallowing  Larynx –Uppermost structure of the lower airway

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Anatomy Review

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Anatomy Review  Gag reflex –Protective response –May lead to vomiting

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 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?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Physiology  Signs of an obstructed airway –Unconsciousness –Snoring sound is indicative of a partial obstruction –Breathlessness (apnea) –Blue discoloration (cyanosis)

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Jaw Thrust  View this video clip demonstrating the jaw thrust maneuver  The animation of this maneuver shows how it opens the airway

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Assess  Any condition that may affect the patency of the airway should be found and addressed –Secretions –Foreign matter –Broken teeth, dental hardware

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27 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?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 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!

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29 Suction  The suction machine –Manual suction –Electric suction

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31 Suction

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Suction  Water –Suction setup should have water available to enable cleaning of the catheter if it becomes clogged

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 34 Suction  The procedure –Open the airway –Preoxygenate patient –Assemble equipment –Measure catheter –Open mouth using cross-finger technique –Suction no more than 15 seconds

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 35 Suction  Watch this video clip demonstrating suctioning

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 36 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 37 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 38 Secure

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 39 Secure  Watch this video clip for demonstration of insertion of the OPA  The animation of this maneuver shows how it opens the airway

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 40 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 41 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

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 42 Secure

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 43 Secure  Watch this video clip demonstrating insertion of an NPA

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 44 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.