Chapter 9: Airway Management
Topics
● Airway Physiology
● Airway Pathophysiology
● Opening the Airway
● Obstructed Airway
● Airway Adjuncts
● Sunctioning
● Keeping an Airway Open: Definitive Care
● Special Considerations
Airway Physiology
The airway is divided into upper and lower portions
Upper airway:
● Begins at the mouth and nose
● The pharynx lies posterior and inferior to the mouth and nose
● Nasopharynx is the upper portion
● Oropharynx is the middle portion
● Laryngopharynx is the lower portion
● The larynx is the boundary between the upper and lower airways
Lower airway:
● The trachea lies below the pharynx
● Mainstream bronchi branch from the trachea and progressively become smaller
● Alveoli lie at the end of the bronchi
● Pulmonary capillaries surround the alveoli
● Oxygen and carbon dioxide are exchanged at the capillaries
Airway Physiology-Pediatric Airway Physiology
Airway structures of infants and children are shorter, narrower, and less rigid than in adults
Mouth and nose are smaller and easily obstructed
Tongue is proportionately larger
Newborns and infants are nose breathers
The trachea is softer, more flexible, and narrower and easily obstructed by swelling and foreign
objects
The chest wall is softer
Breathing is more dependent on the diaphragm
Airway Pathophysiology
A variety of obstructions interfere with air flow
● Foreign bodies, including food and small toys
● Liquids, including blood and vomit
● Loss of muscle tone, as with altered mental status
Obstructions can be acute or chronic
The airway must be initially evaluated and monitored for patency over time
, Severe allergic reaction (anaphylaxis) causes rapid airway tissue swelling
Burns, blunt force trauma, and certain infections cause swelling of the tissues in and around the
glottic opening
Smooth muscle constriction of the lower airway changes the airway diameter and creates
resistance
Airway Pathophysiology-Sounds of a Partially Obstructive Airway
Four sounds can be indicative of limited air movement:
● Stridor-High-pitched whistling sound; indicative of a severely narrowed air passage
● Hoarseness-Raspy change in voice; indicative of swelling around the vocal cords
● Snoring-Similar to a snore during sleep; indicative of diminished muscle tone
● Gurgling-Bubbling sound; indicative of vomit, blood, or secretions in the airway
Patient Assessment-Is the Airway Open?
Two questions must be answered when assessing the airway
● Is airway open?
● Will airway stay open?
The ability to speak is an immediate indicator that the patient is capable of moving air
Stridor may be present on inhalation, exhalation, or both and is an ominous sign
Breathing sounds from the nose and mouth should be free of sounds with obstruction
● Gurgling
● Gasping
● Crowing
● Wheezing
● Snoring
Some patients use body position to keep the airway open
Assess the airway in the primary assessment and stop and fix problems immediately
Patient Assessment-Will the Airway Stay Open?
Airway assessment is not just a moment in time, but a constant consideration
● This is especially true in critical care patients
You may need to consider how to keep an airway open immediately after establishing it
When the airway is partially obstructed, you must consider how long until it will be completely
obstructed
The ability to maintain an airway can change over time
Mental status affects the ability to maintain an airway
There is no guarantee an airway will remain open
Patient Assessment-Signs of an Inadequate Airway
● No signs of breathing or air movement
● Evidence of foreign bodies in the airway
● No air felt or hear at the nose or mouth
● Unusual hoarse or rapsy quality to the voice
● Absent, minimal, or uneven chest movement
Topics
● Airway Physiology
● Airway Pathophysiology
● Opening the Airway
● Obstructed Airway
● Airway Adjuncts
● Sunctioning
● Keeping an Airway Open: Definitive Care
● Special Considerations
Airway Physiology
The airway is divided into upper and lower portions
Upper airway:
● Begins at the mouth and nose
● The pharynx lies posterior and inferior to the mouth and nose
● Nasopharynx is the upper portion
● Oropharynx is the middle portion
● Laryngopharynx is the lower portion
● The larynx is the boundary between the upper and lower airways
Lower airway:
● The trachea lies below the pharynx
● Mainstream bronchi branch from the trachea and progressively become smaller
● Alveoli lie at the end of the bronchi
● Pulmonary capillaries surround the alveoli
● Oxygen and carbon dioxide are exchanged at the capillaries
Airway Physiology-Pediatric Airway Physiology
Airway structures of infants and children are shorter, narrower, and less rigid than in adults
Mouth and nose are smaller and easily obstructed
Tongue is proportionately larger
Newborns and infants are nose breathers
The trachea is softer, more flexible, and narrower and easily obstructed by swelling and foreign
objects
The chest wall is softer
Breathing is more dependent on the diaphragm
Airway Pathophysiology
A variety of obstructions interfere with air flow
● Foreign bodies, including food and small toys
● Liquids, including blood and vomit
● Loss of muscle tone, as with altered mental status
Obstructions can be acute or chronic
The airway must be initially evaluated and monitored for patency over time
, Severe allergic reaction (anaphylaxis) causes rapid airway tissue swelling
Burns, blunt force trauma, and certain infections cause swelling of the tissues in and around the
glottic opening
Smooth muscle constriction of the lower airway changes the airway diameter and creates
resistance
Airway Pathophysiology-Sounds of a Partially Obstructive Airway
Four sounds can be indicative of limited air movement:
● Stridor-High-pitched whistling sound; indicative of a severely narrowed air passage
● Hoarseness-Raspy change in voice; indicative of swelling around the vocal cords
● Snoring-Similar to a snore during sleep; indicative of diminished muscle tone
● Gurgling-Bubbling sound; indicative of vomit, blood, or secretions in the airway
Patient Assessment-Is the Airway Open?
Two questions must be answered when assessing the airway
● Is airway open?
● Will airway stay open?
The ability to speak is an immediate indicator that the patient is capable of moving air
Stridor may be present on inhalation, exhalation, or both and is an ominous sign
Breathing sounds from the nose and mouth should be free of sounds with obstruction
● Gurgling
● Gasping
● Crowing
● Wheezing
● Snoring
Some patients use body position to keep the airway open
Assess the airway in the primary assessment and stop and fix problems immediately
Patient Assessment-Will the Airway Stay Open?
Airway assessment is not just a moment in time, but a constant consideration
● This is especially true in critical care patients
You may need to consider how to keep an airway open immediately after establishing it
When the airway is partially obstructed, you must consider how long until it will be completely
obstructed
The ability to maintain an airway can change over time
Mental status affects the ability to maintain an airway
There is no guarantee an airway will remain open
Patient Assessment-Signs of an Inadequate Airway
● No signs of breathing or air movement
● Evidence of foreign bodies in the airway
● No air felt or hear at the nose or mouth
● Unusual hoarse or rapsy quality to the voice
● Absent, minimal, or uneven chest movement
