WMN Editors

AIRWAY PART II: EMERGENCY AIRWAY MANAGEMENT

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WMN-Cover-26.6

ISSN-1059-6518

AIRWAY-PART II – EMERGENCY AIRWAY MANAGEMENT

By Frank Hubbell, DO

Illustrations by T.B.R. Walsh

The PURPOSE of Airway Adjuncts:

 

The purpose of airway adjuncts is to maintain a patent, open airway. This is accomplished primarily by preventing the tongue or other soft tissues from occluding the entrance to the airway at the larynx.

 

These airway adjuncts are divided into three categories.

1.     There are primary airways for immediate support of the airway

2.     Intermediate airways designed for longer-term use.

3.     Total airway control airways, which require endotracheal intubation that not only maintain an open, patent airway, but also help to prevent aspiration of fluids into the lungs.

 

REMEMBER: Primary and intermediate airway adjuncts do not necessarily prevent the aspiration of saliva, blood, vomitus, or other fluids from getting into the trachea and lungs.

 

IMMEDIATE TECHNIQUES for ESTABLISHING and  MAINTAINING an OPEN AIRWAY:

 

PRIMARY AIRWAYS:

 

The RECOVERY POSITION:            recovery-position

 

This is the quickest and simplest way to establish and maintain an open airway in an unconscious patient. You simply have to know how to properly safely logroll someone onto his or her side.

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WMN Editors

AIRWAY PART I: ANATOMY and PHYSIOLOGY of the RESPIRATORY SYSTEM

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ISSN-1059-6518

 

The Challenges of Emergency Airway Management:

 By Frank Hubbell, DO

Illustrations by T.B.R. Walsh

First, let’s define the problem:

 

1.     When the need for emergency airway management arises, it is usually a scene that is already difficult, desperate, rapidly deteriorating. A scene that most likely requires critical care skills. One of those rare times where speed is of the essence.

2.     Your patient may be unruly, uncooperative, or even intoxicated.

3.     Your patient will most likely already be hypoxic with poor oxygenation and decreasing respiratory and ventilatory efforts. As a result they will not tolerate even short periods of apnea or hypoxia.

4.     Your patient may have recently eaten or drank, and these stomach contents dramatically increase the risk of vomiting and with the risk of aspiration.

5.     Their airway may already be compromised by blood, vomitus, secretions, or distorted anatomy from trauma.

6.     Your patient may be a cardiac arrest or a near-arrest situation.

 

OXYGEN: Let’s begin this discussion with oxygen.

 

When we talk about the importance of maintaining an open airway, what we are really talking about is the importance of a constant, uninterrupted flow of oxygen to every cell in the body. The cells with the greatest demand, and therefore the most sensitive tissues to oxygen supply, are the nerve cells that make up the brain. These neurological tissues can only survive intact for 4 – 6 minutes without oxygen; after 10 minutes without

O2 , irreversible brain damage occurs and most likely death.

 

The human brain makes up 2% of our total body weight, but it is hypermetabolic:

– it requires 15% of our cardiac output,

– 20% of total body oxygen consumption, and

– 25% of the total body utilization of glucose.

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