Airway Management

What structures make up the upper airway?

Nose, mouth, pharynx, and larynx.

What structures make up the lower airway?

Trachea, bronchi, bronchioles, and alveoli.

What is the primary muscle of respiration?

The diaphragm.

What happens during inhalation?

The diaphragm and intercostal muscles contract, chest volume increases, and negative pressure draws air into the lungs.

What happens during normal exhalation?

Respiratory muscles relax and the lungs passively recoil.

Where does gas exchange occur?

In the alveoli.

During gas exchange, where does oxygen move?

From the alveoli into the pulmonary capillary blood.

During gas exchange, where does carbon dioxide move?

From the blood into the alveoli to be exhaled.

What carries most oxygen in the blood?

Hemoglobin in red blood cells.

What is a normal adult respiratory rate in this lesson?

12–20 breaths/min.

What findings suggest adequate breathing?

Normal rate, depth, and effort with good skin color and clear breath sounds.

What findings suggest inadequate breathing?

Abnormal rate, shallow or labored breathing, cyanosis, or abnormal breath sounds.

What can obstruct the airway in an unconscious patient?

The tongue can fall backward and block the airway.

What medical conditions listed can narrow the airway?

Asthma, COPD, and anaphylaxis.

What does Look, Listen, Feel assess?

Chest movement, breath sounds/noises, and air movement.

What signs indicate increased work of breathing?

Accessory muscle use and nasal flaring.

What does pulse oximetry measure?

Oxygen saturation in the blood.

What does capnography help assess?

Carbon dioxide levels and effectiveness of ventilation.

Which airway-opening maneuver is used when no spinal injury is suspected?

Head-tilt chin-lift.

Which airway-opening maneuver is preferred when spinal injury is suspected?

Jaw thrust.

What position may help an unconscious patient who is breathing adequately maintain the airway?

Recovery position.

What position often helps a patient with respiratory distress breathe more easily?

Sitting upright.

How does the head-tilt chin-lift open the airway?

It lifts the tongue away from the back of the throat.

Why is head-tilt chin-lift avoided with suspected cervical spine injury?

It moves the neck and may worsen spinal injury.

How does the jaw-thrust maneuver open the airway?

It moves the jaw forward while keeping the neck in a neutral position.

What is the purpose of the recovery position?

To help maintain an open airway and allow fluids to drain from the mouth.

Which suction tip is used for the mouth?

A rigid Yankauer tip.

Which suction catheter is used for the nose or tracheostomy?

A flexible catheter.

What is the maximum suction time for an adult in this lesson?

No more than 15 seconds at a time.

How is nasopharyngeal suction depth measured?

From the nose to the earlobe.

What is the typical flow rate for a nasal cannula?

1–6 L/min.

What approximate oxygen concentration can a nasal cannula deliver?

About 24–44%.

What is the typical flow rate for a simple face mask?

6–10 L/min.

Why must a simple face mask run at least 6 L/min?

To reduce carbon dioxide buildup in the mask.

What approximate oxygen concentration can a simple face mask deliver?

About 40–60%.

What is the typical flow rate for a nonrebreather mask?

10–15 L/min.

What oxygen concentration can a nonrebreather mask deliver according to the lesson?

Up to about 95%.

What must you check on a nonrebreather mask before and during use?

The reservoir bag should remain at least partially inflated.

Which oxygen device is appropriate for a stable patient needing low to moderate oxygen?

Nasal cannula.

Which oxygen device is appropriate for severe respiratory distress or significant hypoxia when the patient is breathing adequately?

Nonrebreather mask.

When is an OPA indicated?

In an unresponsive or deeply unconscious patient without a gag reflex.

What should you do if an OPA causes gagging or retching?

Remove it.

How is an OPA sized?

From the corner of the mouth to the tip of the ear.

How is an adult OPA inserted according to the lesson?

Insert with the tip toward the roof of the mouth, then rotate 180 degrees as it advances.

Where should the OPA flange rest?

On the patient's lips.

When is an NPA useful?

In a semi-conscious patient who needs an airway adjunct and can tolerate the nasal route.

How is an NPA sized?

From the tip of the nose to the earlobe.

What should be applied to an NPA before insertion?

Lubricant.

What should you do if you meet resistance while inserting an NPA?

Try the other nostril.

What major contraindication to NPA use is listed?

Suspected skull base fracture.

When should BVM ventilation be provided?

When a patient is not breathing or is breathing inadequately.

What are examples of inadequate breathing requiring BVM support?

Slow, shallow, gasping, noisy, or otherwise ineffective breathing.

Should BVM ventilation be delayed while waiting to attach oxygen?

No. Begin ventilation first and attach oxygen as soon as possible.

What is the goal when squeezing a BVM?

Deliver just enough volume to produce visible chest rise.

Why is overventilation dangerous?

It can cause lung injury, increase intrathoracic pressure, and reduce cardiac output.

What is the adult ventilation rate given in the lesson for BVM ventilation?

About 1 breath every 6 seconds, or about 10 breaths/min.

How long should each adult BVM breath be delivered over?

About 1 second.

What should happen between BVM breaths?

Allow the chest to fall fully before the next breath.

If the patient is breathing spontaneously, when should assisted breaths be delivered?

During the patient's inhalation.

What hand position is used for a one-person BVM mask seal?

The E-C clamp technique.

Why is two-person BVM ventilation often more effective?

One provider can use both hands to maintain the mask seal while the other squeezes the bag.

Who should manage the mask during two-person BVM ventilation?

The more experienced provider, because maintaining the seal is the hardest part.

What are common causes of ineffective BVM ventilation?

Poor mask seal, poor positioning, obstruction, inadequate airway adjunct use, or equipment problems.

What should you do first if BVM ventilation is difficult?

Reposition the airway and improve the mask seal.

What airway adjuncts can improve BVM ventilation?

OPA or NPA when appropriate.

What is a supraglottic airway?

An advanced airway that sits above the glottis and provides a more secure airway than BVM alone.

What supraglottic airway devices are listed?

LMA, King LT, and i-gel.

What is one advantage of supraglottic airways over endotracheal tubes?

They are easier to insert and do not require direct visualization of the vocal cords.

What is one limitation of supraglottic airways?

They are less secure than an ET tube and may not fully protect against aspiration.

What does CPAP do physiologically?

Provides continuous positive pressure that helps keep alveoli open, improve gas exchange, and reduce work of breathing.

What conditions are listed as common CPAP indications?

CHF/pulmonary edema, COPD exacerbation, and some pneumonias.

What mental status is required for CPAP in this lesson?

The patient must be alert and able to follow commands.

What breathing requirement must be met before CPAP?

The patient must maintain adequate spontaneous respiratory effort.

What minimum systolic blood pressure is required for CPAP in this lesson?

At least 90 mmHg.

Why can CPAP worsen hypotension?

Positive pressure can reduce venous return, lowering cardiac output and blood pressure.

What should be monitored during CPAP?

Respiratory status, SpO2, and blood pressure.

What initial CPAP pressure range is suggested for most respiratory distress patients?

About 5–7.5 cmH2O.

What CPAP pressure range may be used for pulmonary edema from CHF according to the lesson?

About 7.5–10 cmH2O.

Roughly what oxygen flow may be needed for 5 cmH2O of CPAP in this lesson?

About 8–10 L/min.

When should CPAP be stopped and BVM ventilation started?

If LOC decreases, respiratory effort becomes inadequate, SBP falls below 90, or hypoxia worsens despite CPAP.

Why should a BVM be ready whenever CPAP is used?

Because the patient may deteriorate and require immediate assisted ventilation.

What is the EMT's main role with endotracheal intubation?

Assist the advanced provider with equipment, positioning, ventilation, and confirmation/monitoring.

How can ET tube placement be confirmed according to the lesson?

Chest rise, bilateral breath sounds, and end-tidal CO2 monitoring.

Why must an ET tube be secured after placement?

To prevent dislodgement.

Why is pediatric airway positioning different from adults?

A larger occiput can flex the neck and obstruct the airway when the child lies flat.

What positioning aid may help an infant or young child maintain a neutral airway?

A small towel or shoulder roll.

Why are children more prone to tongue-related airway obstruction?

Their tongues are proportionally larger relative to the mouth.

Why can small amounts of swelling severely affect a pediatric airway?

The airway diameter is small, so small decreases in diameter greatly increase resistance.

How does the pediatric larynx differ from the adult larynx?

It sits higher and more anteriorly.

What is an important BVM principle in pediatric patients?

Use smaller volumes and gentle pressure to avoid overinflation.

What airway challenges are common in geriatric patients?

Decreased muscle tone, loose/missing teeth, cervical stiffness, reduced gag reflex, and aspiration risk.

Which airway maneuver should be used in trauma with suspected cervical spine injury?

Jaw thrust.

What trauma findings can complicate airway management?

Facial trauma, bleeding, swelling, neck injury, and chest trauma.

What patient features can predict a difficult airway?

Obesity, short neck, small mandible, large tongue, or limited mouth opening.

What position can improve airway alignment in obese patients?

Ramped position.

What BVM technique is especially useful for difficult airways?

Two-person BVM ventilation.

In cardiac arrest, what takes priority over advanced airway placement?

High-quality CPR with minimal interruption.

What should be done if BVM ventilation becomes difficult during cardiac arrest?

Reposition, check for obstruction, suction if needed, and consider airway adjuncts or advanced airway support.

What airway findings suggest anaphylaxis?

Swelling of the lips/tongue/throat, stridor, and respiratory distress.

What medication is emphasized for anaphylaxis?

Epinephrine.