Airway management involves the evaluation, planning, and execution of a set of medical procedures necessary to preserve or restore an individual's ventilation, or breathing. This technique helps air to flow from the nose and mouth into the lungs by keeping an open airway in times of crisis.
Airway management is a crucial part of CPR training in NZ and a key skill for doctors or other healthcare professionals in life-threatening circumstances. It’s invaluable, especially for emergency medical practice. In cases when airway management is essential, a lack of it might result in persons having low blood oxygen levels, which can be very dangerous, and even fatal for the individual.
What are the different types of artificial airways?Professionals in NZ use three kinds of medical devices to maintain or open a person’s airway, namely:
Meanwhile, the NPA is a tube that is inserted into the nasal passages to keep the airway open. NPAs are sometimes better tolerated than OPAs and should be considered when OPA usage is unrecommended, such as when a person's jaw is clenched or when they are responsive.
Finally, an ETA is a plastic tube that is put into the trachea or windpipe via the mouth. The ETA is then attached to a ventilator, which provides oxygen to the lungs manually.
When is airway management required?Individuals in a number of situations, ranging from simple choking to complex airway blockage, might need airway care. Airway blockage is most usually caused by the tongue or when a foreign item obstructs the airway. It can also be caused by airway damage, an increase in blood and secretions (such as saliva and mucus), or airway inflammation.
Clinical symptoms for airway care include:
Basic airway management can be performed singularly or in combination with other airway management procedures to treat moderate airway blockages such as choking. The basic form of airway management involves the use of non-invasive procedures that do not need the use of specialist medical equipment. Airway care techniques, such as chest compressions, abdominal thrusts, and back blows are examples that can be done singularly or in combination to remove the foreign body from blocking the airway. If the person is unresponsive to these treatments, they might need cardiopulmonary resuscitation (CPR), since chest compressions provide higher airway pressures to clear the blockage than belly thrusts.
Additionally, the head tilt/chin lift and jaw push are fundamental airway control techniques, used to avoid airway blockage in unconscious individuals by keeping the tongue from blocking the upper airway. These techniques are usually included in CPR training in NZ. The head-tilt/chin-lift is not advised for people who have a history of cervical spine injury or upper spine damage in the neck. On the other hand, when cervical spine damage is suspected, the jaw-thrust procedure is appropriate.
In cases of insufficient ventilation, which might happen during difficulty breathing or airway blockage, bag valve mask ventilation could be necessary. Positive pressure is used to force air into the individual's chest during this intervention. Choosing to mask ventilate requires preserving an open airway, securing the individual's mouth and nose with a mask, and maintaining adequate ventilation (e.g., volume, rate, and tempo) throughout the intervention. Monitoring bag valve mask ventilation carefully requires studying the patient to see that there’s a chest rise during each cycle of breathing.
After establishing an open airway with basic management methods, advanced airway management strategies can be performed. Advanced airway management, an important part of CPR training in NZ, is a term that refers to the use of specialist medical equipment and invasive techniques to open and maintain an airway in critically sick or sedated patients. The most common device used is the Laryngeal Mask Airway (LMA), which is used to maintain an open airway temporarily during anaesthetic administration or as a life-saving strategy in a challenging airway scenario. A difficult airway occurs when three or more efforts lasting more than ten minutes each fail to secure the airway.
Other advanced airway management strategies include the use of OPAs or NPAs as supplemental approaches for maintaining an open airway in persons who are profoundly unconscious. Both kinds of airway devices will keep the tongue from obstructing the airway and will provide enough ventilation, but they will not protect the trachea from respiratory secretions or stomach contents rising into the airway (i.e. regurgitation).
In life-threatening conditions, such as respiratory failure, airway damage, or reduced levels of consciousness, an ETA can be performed along with Endotracheal Intubation (ETI) to maintain an open airway and channel for medicine administration (if required). The ETA is injected into the trachea through the mouth and vocal cords. Clinical indicators of effective intubation include mist in the ETA, chest lift with each breath and breath sounds from air movement in both lungs. Rapid sequence induction (RSI) of anaesthetic and intubation may be used in an emergency or urgent circumstance, such as during cardiac arrest. The RSI procedure is carried out by producing unconsciousness and muscular relaxation using a variety of medicines.
Finally, if alternative techniques of airway management fall ineffective or aren’t allowed in a given situation, surgical intervention for airway management might be necessary.
Cricothyrotomy is a surgical procedure that involves making an incision in the cricothyroid membrane, which is a crucial condition that links the thyroid and cricoid cartilages of the larynx. Following that, a tracheostomy tube is put into the incision to provide a functional airway. This may be verified by listening to the lungs for breath sounds and seeing the chest rising and falling.
Tracheotomy is another surgical procedure that involves making an incision in the neck to place a breathing tube into the trachea. It is applied in circumstances when persistent (longer) mechanical ventilation is necessary.
What is the most effective method of airway management?In emergency medicine, RSI, which combines ETI with drug administration, has been shown to be the quickest and most effective technique for airway management. RSI is especially beneficial for those who have a functional gag reflex, a full stomach, or who are experiencing life-threatening circumstances that need rapid airway care. This technique, however, may not be appropriate for people who have a history of known or suspected adverse responses to any of the medicines used in RSI.
Additionally, RSI is not encouraged for patients who have a complete airway blockage and needs surgery or who have a difficult airway. Risk factors for a problematic airway include:
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