Airway Management

Advanced First Aid

Introduction and Motivation

[0:00] Aims:

• Understand the place of airway management in First Aid
• Be able to detect the signs and symptoms of a blocked airway
• Know how to use manual techniques to clear an airway
• Be able to use appropriate mechanical aids to maintain an airway

Motivation

• Any other treatment is pointless if airway is compromised
• Blocked airways kill in minutes
• The airway is ALWAYS the priority

Anatomy and Physiology

[02:00] The Upper Airway

Sketch diagram:

• Side view of skull
• Show nasal and oral passages
• Note trachea/oesophagus junction
• Signs of upper airway obstruction: gurgling and snoring

[05:00] The Lower Airway

Add to diagram:

• Trachea branching at carina
• Bronchi to bronchioles to alveoli
• Mechanism of gas exchange
• Aerobic vs. anaerobic metabolism
• Signs of lower airway obstruction: stridor and wheezing.
  Breath signs may tell much

Cause and Effect

[08:00] Common causes:

Upper airway

1. Own tongue (u/c)
2. Vomit (especially alcohol-caused)
3. Food (Big Mac!)

Lower airway

1. Asthma (increased mucous)
2. Anaphylaxis (oedema)

[10:00] Effects

• Immediate: no O2 flow to lungs
• Reaction: panic, strenous attempts to breathe
• Consequence: collapse and u/c
• Physiological: anaerobic metabolism
• Consequence: acidosis, damage to tissues inc brain

Manual Techniques

[13:00] Clearing mouth

Don't go diving in deep

Head tilt, chin lift

Method of choice for medical conditions - why?
Trauma contradiction

[15:00]Jaw thrust

Good for head/neck trauma, but:

• Hard to get right
• Hard to hold -- needs 2 hands
• Patient may not be quite u/c enough

Chin lift

Easy to do, but:

• Patient must be gorked, else might bite
• Danger anyway of cutting digit on teeth

Mechanical Adjuncts

[19:00] General points:

All these are adjuncts; only intubation protects trachea

Oral-pharyngeal airway

• What it does
• Method of insertion
• Contra-indication: gag
• Good for head trauma

Naso-pharyngeal airway

• What it does
• Method of insertion
• Contra-indication: head trauma
• Good for semi-conc medical collapse

Suction

Basic guidelines:

• Only suction what you can see
• No more than 15 secs at a time
• Oxygenate in between; aggravates hypoxia

[24:00] Other devices (interest only):

• Multi-lumen airways e.g. PTLA
• Laryngeal mask - Tariq!
• Intubation - definitive

Conclusions

[26:00]

Summary of treatment

• Clear the airway before anything else
• Noise is bad, silence is worse
• Think spinal - do airway
• Choose adjucts appropriately

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