Airway Assessment And Airway Management

Question 1

Aims of Airway assessment and airway management

Answer 1

To maintain a patent airway by allowing a continuos exchange of oxygen and co2 into the lungs( ventilation) by:
Recognising a compromised airway
Identifying location and type of airway obstruction
Selecting the appropriate equipment and technique to maintain open airway and ventilation

Question 2

How do you assess airway?

Answer 2

Listen look and feel

Listen: breath sounds and abnormal noises, snoring, gurgling, crowing/stidor, silence and patient speaking?

Look: patient position, intact structure or trauma, foreign bodies/body fluids, patient colour( cyanotic, pink, pale)

Feel: air flow(expired air misting), chest movements( bilateral/depth/rate), tracheal position

Question 3

Airway obstruction

Answer 3

Airway obstruction is an emergency. Get expert help immediately
Untreated, airway obstruction causes hypoxia and risks damage to the brain, kidneys and heart, cardiac arrest and death.
Look for the signs of airway obstruction:
Airway obstruction causes paradoxical chest and abdominal movements (see-saw respirations) and the use of the accessory muscles of respiration. Central cyanosis is a late sign of airway obstruction
Complete airway obstruction: there are no breath sounds or air flow at the mouth or nose
Partial obstruction: air entry is diminished and often noisy due to the partial blockage

Question 4

Common causes of airway obstruction

Answer 4

Upper airway : tongue(due to unconsciousness), soft tissue swelling, blood,vomit and direct injury

Larynx: foreign material, direct injury, soft tissue swelling

Lower airway:
secretions,oedema,blood
Bronchospasm
Aspiration of gastric contents

Question 5

How to maintain airway patency?

Answer 5

Place patient in recovery position( when possible): left lateral- prevent choking from tongue or vomit

Observe for secretions and obstructions: remove foreign bodies or suction secretions

Open airway with head tilt and chin lift( depending on age): 
Neutral position for infant
Sniffing position child
Backward head tilt/ pistol grip adult
Jaw thrust (all ages)

Question 6

Recovery position

Answer 6

If a person is unconscious but is breathing and has no other life threatening conditions, they should be placed in the recovery position

Putting someone in the recovery position will keep their airway clear and open. It also ensures that any vomit or fluid won’t cause them to choke

Question 7

Types of artificial airway equipment

Answer 7

Oro-pharyngeal airway (Guedel)
Naso-pharyngeal airway
Laryngeal mask airway (LMA)
Endo-tracheal intubation (ETT)
Tracheostomy

Question 8

How do we choose the right size of oro- pharyngeal airway?

Answer 8

Oro-pharyngeal airway will support the tongue on unconscious patients. Select the right size by measuring the oro-pharyngeal airway against the verticals distance between the patient’s incisors and angle of the jaw

Question 9

Suctioning

Answer 9

Clearing of retained or excessive secretions in patient’s respiratory tract
Purposes:
Prevent secretions obstructing airway
Improve ventilation/gas exchange
Reduce the risk of atelectasis( collection of mucus in lungs)

Question 10

Nursing assessment

Answer 10

Inspect: respiration rate for a full minute, symmetric chest movement, for increased WOB ( work of breathing) , skin for colour, evidence of bruising, deformity or injury
Oxygen saturation( pulse oximetry)>96%-100%

Palpate: for pain , crepitus, chest expansion

Percuss: tapping on chest to identify underlying structures

Auscultate: use stethoscope to listen to chest using step ladder approach

Diagnostic tests: Arterial blood gases(ABG), CXR (chest X-ray)