Airway Management Techniques

• Airway management includes techniques and procedures to prevent or relieve airway obstruction, ensuring adequate ventilation and oxygenation.
• This is a core skill for healthcare providers in emergency medicine, anesthesia, and critical care settings.
• The main goal is to ensure a patent airway, which supports effective breathing.

Basic Airway Management

• Basic techniques involve executing the head-tilt/chin-lift and jaw-thrust maneuvers to open the airway by moving the tongue away from the throat.
• Oropharyngeal airways (OPAs) and nasopharyngeal airways (NPAs) are adjuncts that maintain airway patency.
• OPAs prevent the tongue from blocking the airway and are inserted into the mouth of unconscious patients due to the risk of gagging in semi-conscious ones.
• NPAs go through the nose into the pharynx and are typically more tolerable for semi-conscious patients.
• Bag-valve-mask (BVM) ventilation uses a mask connected to a self-inflating bag to provide manual ventilation; it needs a tight seal between the mask and the patient's face.
• Proper BVM technique and training are needed to prevent complications like gastric distension and aspiration.

Advanced Airway Management

• Advanced techniques use specialized equipment to secure and maintain the airway.
• Endotracheal intubation (ETI) involves inserting a tube into the trachea to create a definitive airway.
• A laryngoscope is used to visualize the vocal cords during ETI.
• Confirmation of correct tube placement includes checking for chest rise, auscultating breath sounds, and using capnography.
• Laryngeal mask airways (LMAs) are supraglottic devices placed into the pharynx to seal around the larynx, serving as an alternative to ETI.
• LMAs are easier in insert than ET tubes and doesn't require direct visualization of the vocal cords
• LMAs are useful when ETI is difficult or impossible.
• Cricothyrotomy creates an incision through the cricothyroid membrane to establish an airway.
• The procedure is performed during emergencies if ETI and other techniques have failed.
• Tracheostomy involves surgically opening the trachea to insert a tube for long-term airway management.

Indications for Airway Management

• Airway obstruction can result from foreign bodies, trauma, or swelling.
• Respiratory failure is characterized by not enough oxygenation or ventilation.
• Decreased consciousness can impair the ability to protect the airway.
• Prolonged mechanical ventilation may be needed.
• Aspiration risk should be considered.

Assessment of the Airway

• Thorough assessment includes evaluating consciousness, respiratory effort, and oxygen saturation.
• Look for signs of airway obstruction, including stridor, gasping, or cyanosis.
• The "look, listen, and feel" approach is observing chest movement, listening for breath sounds, and feeling for airflow.
• The Mallampati score assesses the visibility of oropharyngeal structures to predict intubation difficulty.
• A higher Mallampati score means the airway will be more difficult.
• The LEMON mnemonic assesses Look, Evaluate (3-3-2 rule), Mallampati, Obstruction, and Neck mobility for airway difficulty.

Equipment for Airway Management

• Oxygen source and delivery devices include a nasal cannula, face mask, and non-rebreather mask.
• Suction equipment helps to clear secretions and foreign material from the airway.
• Oropharyngeal and nasopharyngeal airways can be used.
• A bag-valve-mask (BVM) resuscitator.
• Laryngoscope with various blade sizes.
• Endotracheal tubes with different sizes.
• Laryngeal mask airways (LMAs).
• Stylet or bougie to aid in the insertion of the endotracheal tube.
• Capnography monitors carbon dioxide levels and confirms the endotracheal tube placement.
• Medications for sedation and neuromuscular blockade (as needed).

Techniques for Airway Management

• Preoxygenation involves administering 100% oxygen prior to intubation to increase the patient's oxygen reserves.
• Positioning involves optimizing the patient's position with the sniffing position to improve airway visualization.
• Rapid Sequence Intubation (RSI) is a technique that uses a sedative and neuromuscular blocking agent to facilitate rapid intubation.
• Confirmation of Tube Placement includes observing chest rise, auscultating breath sounds, using capnography and a chest X-ray.
• Suctioning is done by removing secretions from the airway to maintain patency.
• Extubation is the removal of the endotracheal tube when the patient can maintain adequate ventilation and oxygenation independently.

Monitoring During Airway Management

• Continuous monitoring of oxygen saturation (SpO2) via pulse oximetry.
• Continuous monitoring of end-tidal carbon dioxide (ETCO2) via capnography.
• Continuous monitoring of heart rate and blood pressure.
• Regular assessment of breath sounds and chest rise.

Complications of Airway Management

• Hypoxia is inadequate oxygen delivery to the tissues.
• Hypercapnia means elevated carbon dioxide levels in the blood.
• Aspiration is the inhalation of gastric contents into the lungs.
• Trauma to the airway structures may occur during intubation.
• Esophageal intubation is when the endotracheal tube is placed into the esophagus instead of the trachea.
• Bronchospasm is the constriction of the airways, leading to difficulty breathing.
• Laryngospasm is spasmodic closure of the vocal cords.
• Hypotension is low blood pressure due to medications or positive pressure ventilation.
• Cardiac Arrest may occur in severe cases, due to airway management complications.

Special Considerations

• Pediatric Airway: Children have anatomical differences that include a big tongue, a more anterior larynx, and a narrower trachea.
• Obstetric Airway: Pregnant patients have a higher risk of aspiration and reduced functional residual capacity, needing careful airway management.
• Obese Patients: Obese patients have a higher risk of difficult intubation and desaturation because of increased oxygen consumption and decreased respiratory reserve.
• Trauma Patients: Trauma patients may have cervical spine injuries or facial fractures that complicate airway management, needing specialized techniques.

Training and Competency

• Healthcare providers need comprehensive training in airway management techniques.
• Regular practice and simulation are essential to keep competency.
• Continuing education and updates on new techniques and equipment are important.

Ethical and Legal Considerations

• Informed consent should be obtained whenever possible.
• Implied consent allows for necessary treatment to be provided during emergency situations.
• Documentation of airway management procedures and any complications is essential.
• Adhering to established protocols and guidelines ensures patient safety.