Airway Management

Lecture-3
OBJECTIVES
Air way anatomy
Air way compromise
Oxygen therapy
Advanced airway devices
Airway Status
Airway patency is a term used to describe the
status of the airway.
An open and clear airway is called patent, whereas an
obstructed airway is compromised.
Anatomy of airways
The upper airway is composed of the oropharynx
and nasopharynx
The oropharynx starts at the mouth and ends at the
trachea
The mouth includes the tongue inferiorly and the
hard palate superiorly. The tongue has many
functions, but for our purposes it is only a problem.
Lower Airways
The lower airway consists of the epiglottis and the
larynx. The epiglottis is a flap that covers the opening
to the trachea (the glottis) when food or fluid
passes into the esophagus. The larynx is composed of
nine cartilages and muscles and is located anterior to
the fourth, fifth, and sixth cervical vertebrae in adults.
The larynx is also known as the Adam’s apple. It is a
dynamic structure and protects the glottis while also
allowing phonation.
The tongue is the most common reason for airway
obstruction because in the supine unconscious
athlete it can slide backward and occlude the passage
of air into the trachea
This situation is commonly described as the tongue
being “swallowed,” although swallowing the tongue is
not actually possible.
Sign of obstructed airways
Signs of an obstructed airway include snoring
respirations, sternal and intercostal retractions,
accessory muscle use, and gurgling.
Snoring respirations are common and indicate that
the tongue is partially occluding the airway.
 A smooth and symmetrical expansion of the thorax indicates a normal
respiratory effort.
 The condition in which the upper sternum sinks inward while the
remainder of the sternum expands outward is called sternal retractions
and very little air is exchanged with each breath.
 Intercostal retractions and accessory muscle use mostly describe
difficulty breathing frequently seen with acute asthma attacks and may
or may not be related to airway obstruction.
 Intercostal retractions are seen by examining the chest wall and
looking at the muscles between the ribs.
 If the muscles sink inward while the chest is expanding outward for
inhalation, retractions are present.
 Accessory muscle use describes the contraction of the
sternocleidomastoid muscles of the neck to aid in expansion of the
chest for inhalation.
 Gurgling always indicates fluid in the airway typically either saliva or
vomitus.
Clearing an obstructed airway usually requires
repositioning the head, jaw, and neck
The head tilt–chin lift technique (Fig. 3-2) will
almost always result in a patent airway; However, this
technique cannot be used in the unconscious athlete
who is assumed to have a cervical spine injury.
 Therefore, the jaw thrust, or triple airway,
manoeuvre is more appropriate for an athlete who is
unconscious (Fig. 3-3).
Head tilt–chin lift method
Jaw thrust manoeuvre
Airway Adjuncts
The oropharyngeal (OP) and nasopharyngeal
(NP) airways are used to relieve an obstructed airway
after the initial jaw thrust manoeuvre has shown its
effectiveness.
The adult OP airway comes in small, medium, and
large sizes
Proper sizing is made by holding the airway along the
cheek. It should stretch from the tip of the ear to the
corner of the mouth
Inserting the OP airway requires stabilizing the
tongue with a tongue depressor and sliding the airway
into the posterior oropharynx following the natural
curve of the airway.
The OP airway is inserted with the curve toward the
hard palate until the tip is beyond the middle of the
tongue.
The airway is then rotated into its natural position
with the tip downward and into the posterior pharynx.
Contraindication
This technique is contraindicated in the paediatric
population.
An intact gag reflex as indicated by biting is a
contraindication to placement of an OP airway.
Complications of insertion include damage to the
teeth and hard palate and worsening of the airway
obstruction if not positioned properly
The NP airway is made of soft rubber and comes in
sizes small, medium, and large. Nonlatex airways are
also manufactured and are firmer than the rubber
airways. An alternative sizing scale is 28, 30, 32, and
34 French.
Contraindications to the NP airway are facial trauma
and epistaxis
Oxygen Therapy
A D tank is 20 inches in length and holds 360 L of
oxygen, whereas an E tank is 30 inches in length and
holds 625 L of oxygen
Oxygen administration over a long period (hours) may
lead to hypoventilation or even apnoea.
Note:
COPD is not a contraindication
to short-term administration of high-flow oxygen.
FiO2 and Flow Rates for Various
Devices
Device FiO2(%) Flow Rate
Nasal cannula 25–40 1–6
Simple face mask 40-60 6-10
Reservoir bag face 60–90 10–15
mask
BVM 100 10-15
Pocket mask