Airway management

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In cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid, airway management is the process of ensuring that:

1. there is an open pathway between a patient’s lungs and the outside world, and
2. the lungs are safe from aspiration.

In nearly all circumstances airway management is the highest priority for clinical care. This is because if there is no airway, there can be no breathing, hence no oxygenation of blood and therefore circulation (and hence all the other vital body processes) will soon cease. Getting oxygen to the lungs is the first step in almost all clinical treatments. The ‘A’ is for ‘airway’ in the ‘ABC’ of cardiopulmonary resuscitation.

The simplest way of ensuring an open airway in an unconscious patient is to use a head tilt chin lift technique, thereby lifting the tongue from the back of the throat. A similar effect can be achieved by using a jaw thrust in the case of patients with compromised cervical spine, or if it facilitates artificial ventilation (eg/ with an ambu bag).

In the case of a patient who vomits or has other secretions in the airway, these techniques will not be enough. Suitably trained clinicians may elect to use suction to clean out the airway, although this may not always be possible. A vomiting unconscious patient should be turned into the recovery position when there is no suction equipment available, as this allows (to a certain extent) the drainage of fluids out of the mouth instead of down the trachea.

There are a variety of artificial airways which can be used to keep a pathway between the lungs and mouth/nose. The most commonly used in long term or critical care situations is the endotracheal tube, a plastic tube which is inserted through the mouth and into the trachea, often with a cuff which is inflated to seal off the trachea and prevent any vomit being aspirated into the lungs. Other artificial airways include guedel and laryngeal mask airway (LMA for short).

In the case of a choking patient, laryngoscopy or even bronchoscopy may be performed in order to visualise and remove the blockage.

[edit] See also

• intubation
• endotracheal tube
• laryngeal mask airway
• ventilation

[edit] References