Best Practices in Airway Management Updated:
Basic airway management Basic airway management involves maneuvers that do not require specialized medical equipment in contrast to advanced airway management. It is mainly used in first aid since it is non-invasivequick, and relatively simple to perform. The simplest way to determine if the airway is obstructed is by assessing whether the patient is able to speak.
Back slaps and abdominal thrusts are performed to relieve airway obstruction by foreign objects Inward and upward force during abdominal thrusts Treatment[ edit ] Treatment includes different maneuvers that aim to remove the foreign body that is obstructing the airway.
This type of obstruction most often occurs when someone is eating or drinking. Most modern protocols, including those of the American Heart AssociationAmerican Red Cross and the European Resuscitation Council recommend several stages, designed to apply increasingly more pressure.
Most protocols recommend first encouraging the victim to cough, and allowing them an opportunity to spontaneously clear the foreign body if they are coughing forcefully. If the person's airway continues to be blocked, more forceful maneuvers such as hard back slaps and abdominal thrusts Heimlich maneuver can be performed.
Some guidelines recommend alternating between abdominal thrusts and back slaps while others recommend starting with back slaps first. Abdominal thrusts can also be performed on oneself with the help of certain objects, such as by leaning over a chair.
In adults, there is limited evidence that the head down position can be used for self-treatment of suffocation and appears to be an option only if other maneuvers do not work. A finger sweep can push the foreign body further down the airway, making it harder to remove, or cause aspiration by inducing the person to vomit.
Additionally, there is the potential for harm to the rescuer if they are unable to clearly see the oral cavity for example, cutting a finger on jagged teeth. The jaw thrust maneuver can also open up the airway with minimal spine manipulation Prevention techniques focus on preventing airway obstruction by the tongue and reducing the likelihood of aspiration of stomach contents or blood.
This maneuver involves flexion of the neck and extension of the head at Atlanto-occipital joint also called the sniffing positionwhich opens up the airway by lifting the tongue away from the back of the throat.
Placing a folded towel behind the head accomplishes the same result. The head is in a dependent position so that fluid can drain from the patient's airway; the chin is well up to keep the epiglottis opened. Arms and legs are locked to stabilize the position of the patient The jaw-thrust maneuver is an effective airway technique, particularly in the patient in whom cervical spine injury is a concern.
It is easiest when the patient is positioned supine. The practitioner places their index and middle fingers behind the angle of the mandible to physically push the posterior aspects of the mandible upwards while their thumbs push down on the chin to open the mouth.
When the mandible is displaced forward, it pulls the tongue forward and prevents it from occluding the entrance to the trachea. This position entails having the person lie in a stable position on their side with the head in a dependent position so fluids do not drain down the airway, reducing the risk of aspiration.
Most of these airway maneuvers are associated with some movement of the cervical spine. Even though cervical collars can cause problems maintaining an airway and maintaining a blood pressure,  it is not recommended to remove the collar without adequate personnel to manually hold the head in place.
Advanced airway management In contrast to basic airway management maneuvers such as head-tilt or jaw-thrust, advanced airway management relies on the use of medical equipment.
Advanced airway management can be performed "blindly" or with visualization of the glottis by using a laryngoscope. Advanced airway management is frequently performed in the critically injured, those with extensive pulmonary disease, or anesthetized patients to facilitate oxygenation and mechanical ventilation.
Additionally, implementation of a cuffing system is used to prevent the possibility of asphyxiation or airway obstruction. Examples in increasing order of invasiveness include the use of supraglottic devices such as oropharyngeal or nasopharyngeal airwaysinfraglottic techniques such as tracheal intubation and finally surgical methods.
It remains one of the leading cause of death in children under the age of 5.The best lecture on Airway Management–Ever? Rich Levitan is one of the best teachers on the skills of laryngoscopy–or as he would probably put it, epiglottoscopy.
Here is an hour long lecture he delivered last month at Mount Sinai School of Medicine. It is surely one of the best airway lectures. Airway management is a crucial skill for an emergency practitioner to master.
Failure to secure an adequate airway can quickly lead to death or disability. Review our slideshow for best practices. PRODUCTS: In addition to our specialized programs, Airway Management offers a wide selection of durable medical and oxygen equipment. Position paper EAACI/GA2LEN/EDF/WAO guideline: management of urticaria This guideline is the result of a panel discussion during the Third International Meeting on Urticaria, Urticaria , a joint initiative of the EAACI Dermatology.
Continuous positive airway pressure (CPAP) is a form of positive airway pressure ventilator, which applies mild air pressure on a continuous basis to keep the airways continuously open in people who are not able to breathe spontaneously on their own.
It is an alternative to positive end-expiratory pressure (PEEP). Both modalities stent the lungs' alveoli open and thus recruit more of the lung. Respiratory therapists are known for their expertise in airway management, and nowhere are those skills more valued than in the ICU.
Two AARC members share recent stories illustrating just how important it is to keep best practices top of mind when managing the airway in patients who are critically ill.