Basic Airway Management

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Purpose
Indication

Purpose (Description)

  • Provide support to optimise oxygenation and ventilation using basic techniques of
    • airway opening manoeuvres
    • airway adjuncts
      • oropharyngeal device (OP)
      • nasopharyngeal device (NPA)
    • bag valve mask (BVM)

Indication

  • Clinical diagnosis of respiratory distress
    • Respiratory rate > 35
  • Inadequate oxygenation
    • SaO2 < 90%
    • PaO2 < 60 mmHg on 40% O2
    • A-a gradient > 350 mmHg on 100% O2
  • Inadequate ventilation
    • PaCO2 > 55 mmHg
    • Vital capacity < 15 mL/kg
  • Airway obstruction

Contra-indication

  • No absolute contraindications
  • Device specific contraindications apply
    • Nasopharyngeal airway
      • basilar skull fracture
    • Oro pharyngeal airway
      • responsive patient with intact gag reflex

Complications / Alerts

  • Pitfalls
    • get senior help!
  • Head tilt chin lift
    • cervical spine injury exaserbation
  • Naso pharyngeal airway
    • too long
      • gastric insufflation
      • airway if obstruction if incorrectly placed
      • laryngospasm
      • vomiting / aspiration
    • too short
      • ineffective
      • can push epiglottis into larynx
    • epistaxis
      • blood can obstruct airway
    • intracranial placement through cribiform plate in case of basal skull #
  • Oropharyngeal airway
    • poorly tolerated in awake patient
    • too short
      • ineffective
      • can push epiglottis into larynx
    • vomiting / aspiration
    • laryngospasm
    • airway obstruction if incorrectly placed
    • dental / soft tissue trauma

Preparation

  • Permission (Consent)
    • usually not possible to obtain due to patient condition
  • Place
    • resuscitation bay
  • Personel
    • airway competent clinician
    • airway assistant
  • Positioning
    • supine / upright – as per patient comfort / preference
    • if supine – “sniffing position” ( not if cervical spine injury suspected) – [see later]
    • if obese / large breasts – ramped position
  • Equipment needed [PRINTOUT]
    • universal precautions
    • oxygen source
    • bag-valve-mask device
      • clear face masks, various sizes and shapes
    • airway adjuncts
      • oropharyngeal airways, various sizes
      • nasopharyngeal airways, various sizes
    • suction VIDEO
      • suction source
      • Yankauer suction catheter
    • monitoring
      • pulse oximeter
    • tongue blades or tongue depressors
    • water-soluble lubricant & anesthetic spray
  • Drugs
    • nil initially required

Procedure

  • Pain control (Analgesia & Sedation)
  • Preparation
    • personnel ready
    • equipment ready
    • positioning optimal
  • Process
    • head tilt / chin lift
      • “sniffing position”
        • neck flexed
        • head extended
        • external ear meatus level of sternal notch
    • jaw thrust – pulls tongue forward with mandible
      • stand at the head of the bed
      • place fingers behind angles of mandible
      • displace mandible anteriorly, away from posterior pharynx wall
    • nasopharyngeal airway VIDEO
      • sizing
        • from nostril to external auditory canal
      • anaesthetise nostril (e.g. Cophenylcaine or similar spray)
      • place by lubricated NPA by inserting directly posterior along floor of nose – DO NOT go superior
      • secure to prevent displacement
      • may bilateral to improve oxygenation ventilation
    • oropharyngeal airway VIDEO
      • sizing
        • central incisors to angle of mandible
      • place ” right way up” – use tongue depressor
    • bag valve mask device [see separate section on website]
  • Problems?
    • check for complications & effectiveness

Post Procedure Care

  • Documentation

Past the Basics