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Basic Airway Management (Emergency Medicine)

  • Editor(s): Todd W Thomsen, MD, Gary S Setnik, MD, FACEP
  • Section Editor(s): Phillip M Harter, MD
  • Contributor(s): Carmie Chan, MD
PRE-PROCEDURE
INDICATIONS

 

  • Inadequate respiratory effort
  • Airway obstruction
CONTRAINDICATIONS
  • There are no absolute contraindications to basic airway management
EQUIPMENT

See Figure 23

  • Oropharyngeal airway
  • Nasopharyngeal airways (two)
  • Water-soluble lubricant or anesthetic jelly
  • Bag and mask
  • Oxygen supply
  • Supplies for universal precautions: gloves, mask, eye protection
ANATOMY
Nasal Cavity (See Figure 7), Pharynx (See Figure 9), nasopharynx and oropharynx:
  • On the sides of the nasal cavity are three horizontal turbinates. A properly inserted NPA will pass beneath the inferior turbinate.
  • The pharynx extends from the under surface of the skull to the level of the cricoid cartilage in front, and that of the sixth cervical vertebra behind.
  • The nasopharynx consists of the pharynx from behind the nose to the level of the soft palate.
  • The oropharynx opens anteriorly into the mouth. The palatine tonsil is between the two palatine arches.
Bag-valve mask ventilation.
Figure 1 :  Bag-valve mask ventilation.

Basic airway equipment.
Figure 23 :  Basic airway equipment.

Nasal cavity.
Figure 7 :  Nasal cavity.

Pharynx.
Figure 9 :  Pharynx.


PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures
Head-tilt chin-lift.
Figure 10 :  Head-tilt chin-lift.

Jaw-thrust.
Figure 11 :  Jaw-thrust.

Two-handed bag-valve mask ventilation.
Figure 20 :  Two-handed bag-valve mask ventilation.


POST-PROCEDURE
CARE
  • Many patients requiring bag-valve mask ventilation will require subsequent tracheal intubation and mechanical ventilation.
COMPLICATIONS
  • Exacerbation of cervical spine injuries
  • Iatrogenic airway obstruction (due to improper use of OPA)
  • Soft tissue trauma
  • Vomiting
  • Intracranial placement of NPA
  • Gastric distention
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