Module 4: Airway Management

By the end of this module, you will be able to:

• Understand the anatomy and physiology of the airway.

• Recognize airway obstructions and differentiate between partial and complete obstructions.

• Perform techniques to open and maintain a patent airway.

• Properly use airway adjuncts (OPA and NPA).

• Understand suctioning techniques and indications.

Upper Airway Structures

• Nose and Nasal Passages

• Mouth and Oral Cavity

• Pharynx: Divided into nasopharynx, oropharynx, laryngopharynx.

• Epiglottis: Prevents food from entering the trachea during swallowing.

Lower Airway Structures

• Larynx: Voice box, marks the division between upper and lower airway.

• Trachea: Windpipe leading to the lungs.

• Bronchi and Bronchioles: Air passages within the lungs.

• Alveoli: Site of gas exchange.

Airway Physiology

• Ventilation: Movement of air in and out of the lungs.

• Oxygenation: Process of loading oxygen onto hemoglobin in the bloodstream.

• Respiration: Exchange of gases (oxygen and carbon dioxide) at the cellular level.

Causes of Airway Obstruction

• Tongue: Most common cause in unconscious patients.

• Foreign Bodies: Food, small objects.

• Swelling: Allergic reactions, burns, infections.

• Fluids: Blood, vomit, mucus.

Signs of Airway Obstruction

• Partial Obstruction: Stridor, wheezing, coughing, difficulty speaking.

• Complete Obstruction: No sounds, inability to speak or cough, cyanosis.

Manual Maneuvers

• Head-Tilt/Chin-Lift

  • Used when no spinal injury is suspected.

  • Steps:

    • Tilt the patient's head back gently.

    • Lift the chin to open the airway.

• Jaw-Thrust Maneuver

  • Used when spinal injury is suspected.

  • Steps:

    • Stabilize the head.

    • Push the angles of the lower jaw forward.

Maintaining Airway Patency

• Recovery Position

  • Placing an unconscious but breathing patient on their side to prevent aspiration.

Oropharyngeal Airway (OPA)

• Indications: Unconscious patients without a gag reflex.

• Contraindications: Conscious patients or those with an intact gag reflex.

• Insertion:

  • Measure from the corner of the mouth to the earlobe.

  • Insert upside down and rotate, or use a tongue depressor.

Nasopharyngeal Airway (NPA)

• Indications: Unconscious or semi-conscious patients with an intact gag reflex.

• Contraindications: Severe head trauma, nasal fractures, signs of skull fractures.

• Insertion:

  • Measure from the tip of the nose to the earlobe.

  • Lubricate and insert bevel towards the septum.

Purpose

• Remove secretions, blood, vomit to prevent aspiration and maintain airway patency.

Equipment

• Portable Suction Unit

• Rigid (Yankauer) Catheter: For oropharyngeal suctioning.

• Soft (French) Catheter: For nasopharyngeal suctioning or in infants.

Suctioning Technique

• Time Limits:

  • Adults: No more than 15 seconds.

  • Children: No more than 10 seconds.

  • Infants: No more than 5 seconds.

• Procedure:

  • Rotate the catheter while withdrawing.

  • Monitor patient's oxygenation.

Oxygen Delivery Devices

• Nasal Cannula: Low-flow oxygen (1-6 L/min).

• Non-Rebreather Mask: High-flow oxygen (10-15 L/min).

• Bag-Valve Mask (BVM) : Assists ventilations.

Indications for Oxygen Therapy

• Hypoxia, shock, difficulty breathing, altered mental status.