Basic Airway Management

Basic Airway Management Definition and descriptions • It forms the basis of emergency airway management. Indications • Patients that cannot maintain their airway patency. Procedure 1. Place one hand on the forehead and one head on the chin, push with the palm to tilt the patient’s head backwards, while lifting the jaw to bring the chin forwards. - This causes the tongue from the back of the throat opening the airways. - Safest on patients without head or neck trauma. - In a patient with cervical trauma, a jaw thrust without head extension is used. This is called a jaw thrust manoeuvre. ✓ Place fingers just under the angles of the lower jae and lift with both hands displacing the jaw forward. ✓ If the jaw thrust does not open the airway use the head tilt and chin lift, because maintaining a patent airway is a priority. 2. Jaw thrust moves the tongue anteriorly with the jaw further minimising obstruction, lifting from under the angle of the jaw on both sides, causing the jaw to thrust up and forward. This position is maintained often with assistance from an oral airway adjunct. 3. The tips of both thumbs are used to open the mouth to visualise the oropharynx. 4. If required suction to clear the airway. 5. Once the airway is open and clear, may consider airway adjuncts to maintain patency. • There are two types: - Oropharyngeal airway (OPA): - ✓ Commonly used for patients who are unconscious and have no gag reflex. ✓ J shaped single use plastic device. ✓ Insert the OPA with the tip pointing to the hard palate and then rotate 180 degrees, until the posterior pharyngeal wall past the uvula or insert sideways and then rotate 90 degrees. ✓ How to choose the correct size: ➢ When the flange is at the lips of patient the tip of the airway should be at the angle of the jaw. ✓ Once this is correctly inserted it will hold the tongue away from the posterior wall of the pharynx. ✓ If it is inserted incorrectly or it is too small the OPA can push the tongue against the posterior wall of the pharynx which will close up the airway. ✓ Provides a way from suctioning and prevents the patient from biting an advanced airway. Nasopharyngeal airway (NPA): • ✓ Used for patients who are conscious or semiconscious and have a gag reflex. ✓ Soft and curved hollow tube that can be inserted through the nostril to facilitate ventilation to choose the correct size NPA place the flange of the device at the nostril and the tip should just reach just to the tragus of the ear. ✓ To insert the NPA point the tip of the device away from the maxillary bone using moderate pressure in gentle spiral motion push the device into the nostril. ✓ When inserted correctly the NPA should reach beyond the nasal cavity to the pharynx providing a clear path for ventilation. ✓ If you feel an obstruction during insertion gently withdraw the airway about a cm and rotate it and gently try to insert it again. ✓ If continue to encounter resistance, take it out completely and try inserting it into the other nostril. ✓ Use caution when inserting into patients with severe head trauma. ✓ For patient with known basal skull fracture and OPA is preferred. ✓ NBA can be inserted into patients who are awake or have a cough or a gag reflex. Once airways are in, check that the patient is getting adequate ventilation by listening for breath sounds. Contradictions • Conscious breathing patients Precautions • Potential C-spine injury. Other Information • The positioning of a patient in a lateral position is a basic airway management. - The head should be kept in a natural position with pressure on the soft tissue of the neck avoided. - Padding under the shoulders may assist to achieve and maintain this position.