Airway Management in Basic Life Support: Techniques and Devices

This article explains airway management techniques, devices, and why it is important to manage the airway of the patient in providing basic life support. During airway management, several techniques can be used to open the airway and ensure optimal oxygenation and ventilation. The choice of technique depends on the patient's condition and the skill level of the provider. Two commonly employed techniques for opening the airway are the Head-Tilt-Chin-Lift technique and the Jaw-Thrust maneuver.

• Head-Tilt-Chin-Lift technique: It is a simple technique and can quickly establish a patent airway, allowing for effective ventilation.
• Jaw-Thrust maneuver: An alternative technique used to open the airway when there is a possibility of neck or spinal injury.

Various devices are also utilized to establish and maintain a clear and unobstructed airway. Two commonly used basic airway management devices are oropharyngeal airways and nasopharyngeal airways. For advanced devices, endotracheal tubes and supraglottic airways are commonly used.

• Oropharyngeal airways: A curved plastic device inserted into the patient's mouth to keep the tongue away from the posterior pharyngeal wall, preventing its obstruction of the airway.
• Nasopharyngeal airways: A flexible tube inserted through the nostril into the nasopharynx to maintain the patency of the upper airway.
• Endotracheal tubes: intubation involves the insertion of an endotracheal tube into the trachea through the mouth or nose.
• Supraglottic airways: Alternative advanced airway management options that sit above the vocal cords, providing a patent airway without the need for endotracheal intubation.

Head-Tilt-Chin-Lift Technique

The Head-Tilt-Chin-Lift technique is a basic maneuver used to open the airway by aligning the oral and pharyngeal structures. It is most commonly used when there is no suspicion of neck or spinal injury. It is simple to perform and can quickly establish a patent airway, allowing for effective ventilation. Here's how to perform Head-Tilt-Chin-Lift Maneuver:

1. Approach the patient's head from the side, placing one hand on the patient's forehead and the other under the bony part of the chin.
2. Gently tilt the patient's head backward using the hand on the forehead, applying slight upward pressure.
3. Simultaneously lift the chin forward with the hand under the chin, creating a slight extension at the neck.
4. As the head tilts back and the chin lifts, the tongue is moved away from the back of the throat, opening the airway for effective breathing.

Jaw-Thrust Maneuver

The Jaw-Thrust maneuver is an alternative technique used to open the airway when there is a possibility of neck or spinal injury. This technique avoids movement or manipulation of the head and neck. It is particularly useful in situations where the stability of the cervical spine is a concern. It allows for airway management while minimizing the risk of exacerbating a potential neck or spinal injury. Here's how to perform Jaw Thrust Maneuver:

1. Position yourself at the patient's head, placing your hands on both sides of the patient's jaw near the angles of the mandible.
2. With your fingers behind the angles of the mandible, gently lift and thrust the jaw forward, moving it upward.
3. This maneuver displaces the tongue forward, creating space in the oropharynx and opening the airway for effective breathing.

What Are the Basic Airway Management Devices?

In airway management, various devices are utilized to establish and maintain a clear and unobstructed airway. These devices are designed to assist in overcoming anatomical or physiological challenges that may hinder effective breathing. Two commonly used basic airway management devices are oropharyngeal airways and nasopharyngeal airways.

Oropharyngeal Airway (OPA)

An oropharyngeal airway, also known as an oral airway or Guedel airway, is a curved plastic device inserted into the patient's mouth to keep the tongue away from the posterior pharyngeal wall, preventing its obstruction of the airway. Here are key features and considerations regarding oropharyngeal airways:

1. Design: Oropharyngeal airways consist of a curved tube with flanges or flared ends on one side and a centrally located opening on the other. They are available in various sizes to accommodate different patient populations, from infants to adults.
2. Insertion: To insert an oropharyngeal airway, the device is gently placed into the patient's mouth with the curved portion following the natural curvature of the tongue. Once inserted, it helps maintain the airway patency by keeping the tongue forward and preventing its obstruction of the oropharynx.
3. Indications: Oropharyngeal airways are commonly used in unconscious or sedated patients who have diminished muscle tone and are at risk of airway obstruction due to tongue falling back or airway collapse.
4. Contraindications: Oropharyngeal airways should not be used in patients with a gag reflex, intact oropharyngeal reflexes, or patients who are conscious and can maintain their own airway.

Nasopharyngeal Airway (NPA)

A nasopharyngeal airway is a flexible tube inserted through the nostril into the nasopharynx to maintain the patency of the upper airway. Here are key features and considerations regarding nasopharyngeal airways:

1. Design: Nasopharyngeal airways are constructed from soft, pliable materials such as silicone or latex rubber. They have beveled tips and flanges at the opposite end to secure proper placement and prevent complete insertion.
2. Insertion: To insert a nasopharyngeal airway, lubricate the tip with a water-soluble lubricant, gently insert it through the nostril, and advance it along the floor of the nasal passage until the flange rests at the nostril. The beveled tip helps navigate the nasal passages and minimizes trauma.
3. Indications: Nasopharyngeal airways are commonly used in patients who require assistance in maintaining an open airway but have intact gag reflexes or are conscious. They can be used in situations where oral access is limited, such as facial trauma or seizure activity.
4. Contraindications: Nasopharyngeal airways are contraindicated in patients with suspected basilar skull fractures, severe facial trauma, or nasal obstruction.

Both oropharyngeal and nasopharyngeal airways are valuable tools in airway management, particularly in basic life support situations. They can help maintain airway patency, facilitate oxygenation, and assist in effective ventilation. Proper size selection and appropriate insertion techniques are essential to ensure optimal positioning and minimize the risk of complications.

Advanced Airway Devices

Advanced airway devices are utilized in more specialized medical settings and go beyond the scope of Basic Life Support (BLS). These devices require additional training and expertise for proper insertion and management. Two commonly used advanced airway devices are endotracheal tubes and supraglottic airways.

Endotracheal Tubes (ETT)

Endotracheal intubation involves the insertion of an endotracheal tube into the trachea through the mouth or nose. It is typically performed in critical care settings or during advanced life support interventions. Here are key features and considerations regarding endotracheal tubes:

1. Design: Endotracheal tubes are flexible tubes made of materials such as polyvinyl chloride or silicone. They have an inflatable cuff near the distal end, which, when inflated, creates a seal to prevent air leakage around the tube.
2. Insertion: Endotracheal intubation is a complex procedure that requires specialized training and skill. It involves passing the tube through the vocal cords and securing it in the trachea. Proper positioning is confirmed using clinical signs, chest rise, and capnography.
3. Indications: Endotracheal tubes are indicated in situations where prolonged airway support is needed, such as in cases of respiratory failure, coma, or general anesthesia. They provide a secure airway, allow for mechanical ventilation, and facilitate the suctioning of secretions.
4. Contraindications: Contraindications to endotracheal intubation include severe facial trauma, laryngeal or upper airway pathology, and certain anatomical abnormalities.

Supraglottic Airway Devices

Supraglottic airway devices are alternative advanced airway management options that sit above the vocal cords, providing a patent airway without the need for endotracheal intubation. They are commonly used in emergency medicine and anesthesia settings. Here are key features and considerations regarding supraglottic airway devices:

1. Design: Supraglottic airway devices, such as the laryngeal mask airway (LMA) or the esophageal-tracheal Combitube, are designed to sit in the pharynx and create a seal around the laryngeal inlet, allowing ventilation.
2. Insertion: Inserting a supraglottic airway device involves passing the device through the mouth or nose and positioning it in the oropharynx or hypopharynx. Proper placement is confirmed by assessing chest rise and auscultating breath sounds.
3. Indications: Supraglottic airway devices are used when endotracheal intubation is not feasible or when maintaining an advanced airway is challenging. They are useful in situations such as cardiac arrest, anesthesia induction, or airway management in difficult cases.
4. Contraindications: Contraindications for supraglottic airway devices include severe upper airway obstruction, laryngeal pathology, or a known risk of regurgitation.

Advanced airway management requires specialized training and expertise beyond the scope of BLS. Healthcare providers with the appropriate skills can utilize these advanced airway devices to secure and manage the airway in more complex medical situations.

What is Airway Management?

Airway management refers to a set of techniques and interventions used to establish and maintain a clear and unobstructed airway. It is a critical component of medical care, particularly in emergency situations where a patient's ability to breathe adequately may be compromised. The primary goal of airway management is to ensure the delivery of oxygen to the lungs and the removal of carbon dioxide, optimizing oxygenation and ventilation.

Airway management techniques can range from basic maneuvers, such as head-tilt/chin-lift or jaw thrust, to more advanced interventions like the insertion of airway adjuncts or the use of advanced airway devices. These techniques are tailored to the specific needs of the patient and the severity of the airway obstruction.

Why is airway management crucial in basic life support?

Airway management is crucial in Basic Life Support (BLS) because it ensures the delivery of oxygen to the lungs and facilitates proper ventilation. By establishing and maintaining a clear and unobstructed airway, BLS providers can optimize oxygenation and remove carbon dioxide from the body. This is essential for sustaining cell function and preventing organ damage.

Additionally, effective airway management helps prevent aspiration of fluids or foreign objects, reducing the risk of complications. A patent airway also supports circulation during chest compressions, allowing for the circulation of oxygenated blood to vital organs. Overall, airway management plays a pivotal role in BLS by supporting vital functions and increasing the chances of survival during medical emergencies.

Understanding Basic Life Support (BLS)

Effective airway management is closely tied to other BLS procedures like chest compressions and defibrillation, supporting the circulation of oxygenated blood. Proper training and skill are essential in executing these techniques accurately. Basic Life Support (BLS) refers to a set of essential medical techniques and interventions aimed at providing immediate care to individuals experiencing life-threatening emergencies. BLS is typically administered by healthcare professionals, first responders, or trained bystanders who are equipped with the necessary knowledge and skills. The primary focus of BLS is to support and sustain vital functions, such as maintaining an open airway, ensuring adequate oxygenation and ventilation, and facilitating the circulation of oxygenated blood throughout the body.

One of the primary goals of BLS is to establish and maintain a clear and unobstructed airway. This involves techniques such as head-tilt/chin-lift or jaw thrust to open the airway and ensure adequate oxygen supply to the lungs. A patent airway allows for the effective passage of air during breathing, ensuring the delivery of oxygen to the vital organs. BLS aims to stabilize the patient's condition and improve the chances of survival until more advanced medical care can be provided.

Anatomy of the Airway

The airway anatomy consists of various structures that play a crucial role in allowing air to pass into and out of the lungs. Understanding the anatomy of the airway is essential for effective airway management during medical emergencies. Let's explore the key structures involved in maintaining an open airway.

• Nasal and Oral Cavities: The airway begins at the nostrils and mouth, which lead to the nasal and oral cavities, respectively. These passages help filter, warm, and moisten the inspired air.
• Pharynx: Located behind the mouth and nasal cavities, the pharynx serves as a common pathway for both air and food. It is divided into three regions: the nasopharynx, oropharynx, and laryngopharynx.
• Larynx: Situated at the top of the trachea, the larynx is commonly known as the voice box. It houses the vocal cords and contains several cartilages, including the thyroid cartilage (Adam's apple) and the cricoid cartilage. The larynx plays a crucial role in protecting the lower airway and producing vocal sounds.
• Epiglottis: The epiglottis is a leaf-shaped cartilage located at the base of the tongue and above the larynx. During swallowing, the epiglottis closes over the larynx, preventing food and liquids from entering the airway. 
• Trachea: Commonly known as the windpipe, the trachea is a rigid tube that connects the larynx to the bronchi of the lungs. It is composed of cartilaginous rings that help maintain its structure. The trachea allows for the passage of air to and from the lungs.

What is Pneumothorax?

Pneumothorax is a medical condition in which air or gas accumulates in the pleural cavity, the space between the lungs and the chest wall. This accumulation of air or gas can cause the lung to collapse, leading to difficulty breathing and Chest Pain. Various conditions, including trauma, lung disease, and medical procedures, can cause pneumothorax. A penetrating injury causes traumatic pneumothorax to the chest, such as a stab wound or gunshot wound. It can also be caused by blunt trauma, such as a rib fracture or a motor vehicle accident. A medical procedure, such as thoracentesis or a chest tube insertion, can also cause pneumothorax. Thoracentesis is a procedure in which a needle is inserted into the pleural cavity to remove the fluid. A chest tube is inserted into the pleural cavity to remove air or fluid.

Treatment for a pneumothorax depends on the size and cause of the pneumothorax. Small pneumothoraces may resolve on their own, while larger pneumothoraces may require a chest tube to remove the air or gas. In some cases, surgery may be necessary to repair the lung tissue. If you think you may have a pneumothorax, it is important to seek medical attention immediately. Early diagnosis and treatment can help prevent complications and improve outcomes.

What are the recommendations for maintaining a clear airway in a non-responsive patient?

When dealing with a non-responsive patient, the recommendations for maintaining a clear airway include using the Head-Tilt-Chin-Lift technique or Jaw-Thrust maneuver to open the airway. Check for visible obstructions and remove them if present. Consider using airway adjuncts such as oral or nasal airways to help keep the airway patent. These measures help ensure adequate oxygenation and ventilation in non-responsive patients.

In what situations is airway management necessary in basic life support?

Airway management may be required for individuals in a variety of circumstances, ranging from simple choking to complicated airway obstruction. In Basic Life Support (BLS), ensuring a clear and unobstructed airway is of utmost importance to maintain effective breathing and oxygenation.

Whether it involves performing basic maneuvers like the Head-Tilt-Chin-Lift technique or utilizing advanced techniques and devices, such as clearing obstructions or inserting airway adjuncts, the goal is to establish and maintain an open airway to facilitate proper ventilation and oxygen exchange.

What are the signs of Airway Obstruction?

Signs and symptoms of airway obstruction can vary depending on the degree of blockage, but they generally manifest as difficulties in breathing and inadequate oxygenation. Here are the signs and symptoms associated with a partially or completely blocked airway:

• Abnormal Breathing Sounds (Noisy breathing, gurgling sounds, or high-pitched wheezing)
• Ineffective or Difficult Breathing
• Coughing vigorously
• Inability to Speak or Cry
• Cyanosis (Bluish discoloration of the skin, lips, or nail beds)
• Confusion, restlessness, or even loss of consciousness.

What should be monitored during the process of airway management?

During the process of airway management, it is crucial to monitor several key factors including assessing the patency of the airway to ensure it remains unobstructed, monitoring the person's breathing effort and effectiveness, observing their oxygenation level and color for signs of inadequate oxygenation, monitoring vital signs such as heart rate, blood pressure, and oxygen saturation levels, assessing the person's level of consciousness, and watching for any complications that may arise.

By closely monitoring these factors, healthcare providers can ensure the effectiveness of their interventions, detect any changes or complications promptly, and make necessary adjustments to maintain a clear and open airway throughout the management process.

What are the Common Complications Associated With Airway Management?

Airway management, while essential in medical emergencies, is not without potential complications. Some common complications associated with airway management include:

1. Dental Trauma: Improper insertion of airway devices or aggressive maneuvers during airway management can lead to dental trauma. This may include chipped or fractured teeth, dislodgement of dental prostheses, or damage to the soft tissues of the mouth.
2. Gag Reflex and Vomiting: Inserting airway adjuncts, such as oropharyngeal or nasopharyngeal airways, can trigger the gag reflex in some individuals. This may lead to vomiting, which can further compromise the airway and increase the risk of aspiration.
3. Esophageal Intubation: Improper placement of an endotracheal tube or supraglottic airway device can result in esophageal intubation, where the tube is inserted into the esophagus instead of the trachea. This can lead to inadequate ventilation and compromised oxygenation.
4. Inadequate Oxygenation and Ventilation: Despite efforts to secure the airway, there is a possibility of inadequate oxygenation or ventilation. This can occur due to ineffective mask seals, improper positioning, or incorrect selection of airway devices.
5. Airway Trauma: Invasive airway management techniques, such as intubation, may carry a risk of airway trauma. This can include damage to the vocal cords, tracheal mucosa, or subglottic structures, which can result in bleeding, edema, or difficulty in subsequent intubation attempts.
6. Device Dislodgement or Malfunction: Airway devices, such as endotracheal tubes or supraglottic airways, can become dislodged or malfunction during patient transport or movement. This can compromise the airway and necessitate prompt repositioning or replacement.
7. Aspiration: During airway management, the risk of aspiration exists, especially if the person vomits or has gastric contents present in the stomach. Aspiration can lead to pneumonia or respiratory compromise.

It is important for healthcare providers to be aware of these potential complications and take appropriate measures to minimize their occurrence. This includes proper training, careful technique, frequent monitoring, and prompt response to any signs of complications that may arise during airway management.