Healthcare and Medicine Reference
In-Depth Information
CHAPTER 13
Therapeutic: Airway - Basic Airway
Manoeuvres and Adjuncts
Tim Nutbeam
West Midlands School of Emergency Medicine, Birmingham, UK
The airway is most commonly obstructed by the tongue in an
unconscious patient - it falls backwards to obstruct the pharynx.
OVERVIEW
By the end of this chapter you should be able to:
identify a partially obstructed or blocked airway
Airway manoeuvres
apply a head-tilt/chin-lift and jaw thrust
describe how to size and insert oropharyngeal (OP) and
These manoeuvres are designed to displace the tongue
anteriorly, bringing it forward out of the pharynx and clearing
the airway.
nasopharyngeal (NP) airways
describe how to ventilate a patient using a bag-valve-mask
technique.
Indications
An obstructed or blocked airway.
To assist in ventilation of an unconscious patient.
Introduction
Preparation for or to assist in advanced airway manoeuvres.
Basic airway manoeuvres are life-saving. They are simple to do,
easily learnt and should be readily performed by all healthcare
practitioners. Airway adjuncts are available throughout nearly
all clinical settings; familiarity with their use is vital. Many
patients requiring these procedures are critically ill, and senior
and/or specialist support should be sought at the earliest
opportunity.
Contraindications
Patients who have potential or actual cervical spine injury should
not have a head-tilt/chin-lift as this may exacerbate their injuries:
a jaw thrust should be applied as an alternative.
Head-tilt/chin-lift
Place the fi ngers of one hand under the mandible, gently lift the
1
chin forward.
Use the thumb of the same hand to depress the lower lip and to
The obstructed or blocked airway
2
open the mouth.
The position you are trying to achieve is the 'sniffi ng the
morning air' position seen in Figure 13.1.
It is critical to identify an obstructed or blocked airway and
provide immediate intervention. The airway should be assessed
using a look, listen and feel approach.
Look for:
evidence of obstruction in the airway: blood, vomit, foreign body,
chewing gum, etc.
adequate chest movement
tracheal tug: indicating a completely obstructed airway.
Listen for:
noisy breathing on inspiration (stridor) or expiration
the absence of air movement.
Feel for:
adequate chest movement
air movement at the lips.
Figure 13.1 An open airway 'sniffi ng the morning air position'.
 
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