Summary of "Chapter 11 Airway Management"
Summary of Chapter 11: Airway Management
This video lecture by John from Jacksonville covers comprehensive aspects of airway management, aligned with National EMS Education Standards and the National Registry EMT test. The focus is on understanding airway anatomy, assessment, respiratory physiology, oxygen therapy, artificial ventilation, and related emergency procedures.
Main Ideas and Concepts
1. Airway Anatomy and Physiology
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Upper Airway: Nose, mouth, oral cavity, pharynx (nasopharynx, oropharynx, laryngopharynx), and larynx.
- Functions: Warm, filter, humidify air.
- Important structures: Epiglottis (divides airway and esophagus), thyroid membrane (landmark for cricoid pressure during intubation).
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Lower Airway: Trachea, bronchi, bronchioles, alveoli.
- Functions: Deliver oxygen to alveoli, facilitate gas exchange.
- Cartilage rings in trachea and bronchi prevent collapse; alveoli surrounded by capillaries for oxygen-carbon dioxide exchange.
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Mediastinum: Contains heart, great vessels, trachea, esophagus, and nerves.
2. Respiratory Physiology
- Ventilation: Physical movement of air in and out of lungs (inhalation active, exhalation passive).
- Oxygenation: Loading oxygen onto red blood cells.
- Respiration: Exchange of oxygen and carbon dioxide at alveolar and tissue levels.
- Partial Pressure: Gas exchange driven by differences in partial pressures of oxygen and carbon dioxide.
- Ventilation-Perfusion (V/Q) Ratio: Matching airflow and blood flow is essential for effective gas exchange; mismatch causes hypoxemia.
- Control of Breathing: Chemoreceptors monitor oxygen, carbon dioxide, and pH levels and adjust breathing rate/depth.
3. Airway Obstruction and Causes
- Common Obstruction: Tongue in unconscious patients.
- Intrinsic Factors: Infection, allergic reactions, unresponsiveness.
- Extrinsic Factors: Trauma, atmospheric pressure changes.
- Other Causes: Pneumothorax, pulmonary edema, COPD, shock, blood loss.
- Signs of Obstruction: Noisy breathing, wheezing (lower airway), stridor (upper airway), cyanosis, retractions.
4. Airway Assessment
- Assess breathing rate (12–20 breaths/min normal), pattern, chest rise, lung sounds, skin color, and mental status.
- Recognize abnormal breathing patterns (agonal, Cheyne-Stokes, Kussmaul).
- Use pulse oximetry and end-tidal CO₂ (capnography) to assess oxygenation and ventilation.
5. Airway Management Techniques
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Opening the Airway:
- Head Tilt-Chin Lift (if no spinal injury suspected).
- Jaw Thrust Maneuver (if spinal injury suspected).
- Crossed-finger technique to open mouth if closed.
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Suctioning:
- Use rigid or flexible catheters.
- Suction no longer than 15 seconds for adults (10 seconds during CPR).
- Remove large obstructions manually (“scoop out chunks”).
- Alternate suctioning and ventilating to maintain oxygenation.
6. Airway Adjuncts
- Oropharyngeal Airway (OPA): For unconscious patients without gag reflex.
- Nasopharyngeal Airway (NPA): For patients with gag reflex; contraindicated in severe head trauma or nasal fractures.
- Recovery Position: For unconscious patients without spinal injury to keep airway clear.
7. Oxygen Therapy
- Always provide oxygen to hypoxic patients.
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Delivery Devices:
- Nasal Cannula (1–6 L/min) for mild hypoxia.
- Non-Rebreather Mask (10–15 L/min) for high concentration oxygen.
- Partial Rebreather, Venturi Mask, Tracheostomy Mask (special cases).
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Safety: Handle oxygen cylinders carefully to prevent accidents.
- Hazards: Combustion risk, oxygen toxicity with prolonged high flow.
- Tailor oxygen therapy based on pulse oximetry readings (target >94%).
8. Artificial Ventilation
- Use bag-valve-mask (BVM) for patients with inadequate breathing or apnea.
- Ventilate at 12–20 breaths per minute, with visible chest rise.
- Avoid over-ventilation to prevent gastric distension.
- Mouth-to-mask ventilation less preferred; BVM preferred.
- Use passive ventilation with airway adjuncts during CPR.
- Automatic Transport Ventilators used in transport settings.
9. Continuous Positive Airway Pressure (CPAP)
- Keeps alveoli open, improves oxygenation, reduces need for intubation.
- Indications: Alert patients with moderate to severe respiratory distress, submersion incidents, oxygen saturation <90%.
- Contraindications: Respiratory arrest, inability to protect airway, hypotension, facial trauma, pneumothorax.
- Requires tight mask seal; may cause claustrophobia or worsen pneumothorax.
10. Special Considerations
- Tracheostomy Patients: Airway managed through stoma, bagging directly on trach tube or stoma.
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Airway Obstruction Management:
- Encourage coughing in partial obstruction.
- Heimlich maneuver for conscious choking adults.
- CPR and airway clearance for unconscious obstruction.
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Dental Appliances: Remove loose appliances before ventilation; keep well-fitting dentures in place.
- Facial Bleeding and Swelling: Manage bleeding, be ready to suction, consider airway obstruction risk.
11. Assisting ALS (Advanced Life Support)
- Assist paramedics during intubation (BE MAGIC: Bag, Evaluate, Manipulate, Attempt intubation, Confirm).
- Understand cricoid pressure and airway manipulation techniques.
Methodology / Key Procedures
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Airway Opening:
- Head Tilt-Chin Lift: Place hand on forehead, push back; lift jaw with fingers.
- Jaw Thrust: Hands at crown of head, fingers behind jaw angles, lift jaw without tilting head.
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Suctioning:
- Inspect equipment, test suction.
- Use appropriate catheter.
- Suction mouth/nose max 15 seconds (10 seconds during CPR).
- Alternate suction and ventilation.
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Oxygen Delivery:
- Connect oxygen tank to regulator.
- Use flow meter to adjust flow rate.
- Non-rebreather mask: 10–15 L/min, keep reservoir bag inflated.
- Nasal cannula: 1–6 L/min, humidify if long transport.
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Artificial Ventilation:
- Use BVM with oxygen for apneic or hypoventilating patients.
- Ventilate at 12–20 breaths/min, watch chest rise.
- Avoid excessive ventilation to prevent gastric distension.
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CPAP Use:
- Apply tight-fitting mask.
- Monitor patient for tolerance and contraindications.
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Choking Management:
- Encourage coughing if partial obstruction.
- Heimlich maneuver if severe obstruction and conscious.
- CPR if unconscious.
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Recovery Position:
- Roll unconscious patient onto side to maintain airway and allow drainage.
Speakers / Sources Featured
- John from Jacksonville – Main presenter and lecturer throughout the video.
This summary captures the core lessons, procedures, and critical knowledge points from the video on airway management for EMTs.
Category
Educational
