Chapter 7 Basic Airway Control
Dec 30, 2015
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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
The animation of this maneuver shows how it opens the airway
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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
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
Watch this video clip for demonstration of insertion of the OPA
The animation of this maneuver shows how it opens the airway
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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
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.