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

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

3. 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

4. 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

5. 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

6. 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

7. The Tools OPA

8. 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%

9. 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

10. 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

11. 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

12. 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

13. 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!

14. Questions?