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AIRWAY PART II: EMERGENCY AIRWAY MANAGEMENT

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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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WMN Editors

THE USE OF MEDICAL OXYGEN IN EMS

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ISSN-1059-6518

Volume 26 Number 4

By Frank Hubbell, DO

Illustrations By T.B.R. Walsh

MEDICAL OXYGEN (O2):

To be used on anyone who is exhibiting signs and symptoms of hypoxia:

 

Shortness of breath

Increase or decrease in respiratory rate

– Adult: respiratory rate less than 10 or greater than 30

– Child (1 year – 12 years old): respiratory rate less than 15 or greater than 30

– Infant (0 – 12 months old): respiratory rate less than 25 or greater than 50

Increase in heart rate.

Change in level of consciousness.

Change in skin color: pallor or cyanosis.

 

 Never, ever withhold oxygen from someone who appears to need it.

The following is needed to provide supplemental oxygen to a patient:

✔  O2 tank

✔  Regulator

✔  Delivery device – O2 mask

 

 Medical Oxygen Storage Tanks:

Come in various sizes.

✔ Are identified by color– either the entire tank is green or the curved part of the tank, “the shoulder,” is green

✔ Have an identifying yellow, diamond shaped label on the tank that is marked U.S.P. and Oxygen

✔ Full tanks contain 2000 PSI of pressure and must be handled properly.

 

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WMN Editors

Resiratory Distress

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We breathe in. We breathe out. A dramatic, amazing, perfectly engineered process takes place inside our bodies twelve times each minute, and we hardly even notice.

Before you read any further, do this little experiment. Grab a drinking straw and then get your heart really pumping—run up and down several flights of stairs or sprint across the yard a couple of times. Make yourself good and winded. Now, put the straw in your mouth and breathe through it. Just the straw. Pinch your nose so you don’t cheat. And wait for the panic to set in.

Do we have your attention now? Good. Take the straw out, breathe normally, and read on.

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