Chapter 11: Airway Management

continuous positive airway pressure

A method of ventilation used primarily in the treatment of critically ill patients with respiratory distress; can prevent the need for endotracheal intubation.

dyspnea

Shortness of breath or difficulty breathing.

esophageal intubation

Improper placement of an advanced airway device into the esophagus rather than into the trachea.

inhalation

The active, muscular part of breathing that draws air into the airway and lungs; a medication delivery route.

alveolar minute volume

The volume of air moved through the lungs in 1 minute minus the dead space; calculated by multiplying tidal volume (minus dead space) and respiratory rate.

patent

Open, clear of obstruction.

vital capacity

The amount of air that can be forcibly expelled from the lungs after breathing in as deeply as possible.

capnometry

The use of a capnometer, a device that measures the amount of expired carbon dioxide.

alveolar ventilation

The volume of air that reaches the alveoli. It is determined by subtracting the amount of dead space air from the tidal volume.

bag-mask device

A device with a one-way valve and a face mask attached to a ventilation bag; when attached to a reservoir and connected to oxygen, it delivers more than 90% supplemental oxygen.

respiration

The process of exchanging oxygen and carbon dioxide.

mild airway obstruction

Occurs when a foreign body partially obstructs the patient’s airway. The patient is able to move adequate amounts of air, but also experiences some degree of respiratory distress.

ventilation

The exchange of air between the lungs and the environment; occurs spontaneously by the patient or with assistance from another person, such as an EMT.

compliance

The ability of the alveoli to expand when air is drawn in during inhalation.

passive ventilation

The act of air moving into and out of the lungs during chest compressions.

nasopharyngeal airway

Airway adjunct inserted into the nostril of an unresponsive patient or a patient with an altered level of consciousness who is unable to maintain airway patency independently.

denitrogenation

The process of replacing nitrogen in the lungs with oxygen to maintain a normal oxygen saturation level during advanced airway management.

metabolism

The biochemical processes that result in production of energy from nutrients within the cells; also called cellular respiration.

tracheostomy

A surgical procedure to create an opening (stoma) into the trachea; a stoma in the neck connects the trachea directly to the skin.

carina

Point at which the trachea bifurcates (divides) into the left and right main stem bronchi.

hypoxia

Deficient oxygen concentration in the tissues.

apneic oxygenation

A technique in which oxygen administered via a high-flow nasal cannula is left in place during an intubation attempt, allowing for continuous oxygen delivery into the airways during all phases of the procedure.

intrapulmonary shunting

Bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart.

hypercarbia

Increased carbon dioxide level in the bloodstream.

head-tilt-chin-lift maneuver

A combination of two movements to open the airway by tilting the forehead back and lifting the chin; not used for trauma patients.

American Standard Safety System

A safety system for large oxygen cylinders, designed to prevent the accidental attachment of a regulator to a cylinder containing the wrong type of gas.

barrier device

A protective item, such as a pocket mask with a valve, that limits exposure to a patient’s body fluids.

retractions

Movements in which the skin pulls in around the ribs during inspiration.

surfactant

A liquid protein substance that coats the alveoli in the lungs, decreases alveolar surface tension, and keeps the alveoli expanded; a low level in a premature infant contributes to respiratory distress syndrome.

hemothorax

A collection of blood in the pleural cavity.

aerosol-generating procedure

Any airway manipulation that induces the production of aerosols that may present a risk for airborne transmission of pathogens, such as CPR.

larynx

A complex structure formed by many independent cartilaginous structures that all work together; where the upper airway ends and the lower airway begins; also called the voice box.

aerobic metabolism

Metabolism that can proceed only in the presence of oxygen.

dead space

Any portion of the airway that does contain air and cannot participate in gas exchange, such as the trachea and bronchi.

nasopharynx

The part of the pharynx that lies above the level of the roof of the mouth, or palate.

gag reflex

A normal reflex mechanism that causes retching; activated by touching the soft palate or the back of the throat.

nasal cannula

An oxygen-delivery device in which oxygen flows through two small, tubelike prongs that fit into the patient’s nostrils; delivers 24% to 44% supplemental oxygen, depending on the flow rate.

vocal cords

Thin white bands of tough muscular tissue that are lateral borders of the glottis and serve as the primary center for speech production.

glottis

The space in between the vocal cords that is the narrowest portion of the adult’s airway; also called the glottic opening.

good air exchange

A term used to distinguish the degree of distress in a patient with a mild airway obstruction. If present, the patient is still conscious and able to cough forcefully, although wheezing may be heard.

suction catheter

A hollow, cylindrical device used to remove fluid from the patient’s airway.

agonal gasps

Abnormal breathing pattern characterized by slow, gasping breaths, sometimes seen in patients in cardiac arrest.

bronchioles

Subdivision of the smaller bronchi in the lungs; made of smooth muscle and dilate or constrict in response to various stimuli.

phrenic nerves

The two nerves that innervate the diaphragm; necessary for adequate breathing to occur.

automatic transport ventilator

A ventilation device attached to a control box that allows the variables of ventilation to be set. It frees the EMT to perform other tasks while the patient is being ventilated.

tidal volume

The amount of air (in milliliters) that is moved into or out of the lungs during one breath.

video laryngoscopy

Visualization of the vocal cords, and thereby placement of the endotracheal tube, that is facilitated by use of a video camera and monitor.

stoma

An opening through the skin and into an organ or other structure.

oxygen toxicity

A condition of excessive oxygen consumption resulting in cellular and tissue damage.

external respiration

The exchange of gases between the lungs and the blood cells in the pulmonary capillaries; also called pulmonary respiration.

gastric distention

A condition in which air fills the stomach, often as a result of high volume and pressure during artificial ventilation.

poor air exchange

A term used to describe the degree of distress in a patient with a mild airway obstruction. If present, the patient often has a weak, ineffective cough, increased difficulty breathing, or possible cyanosis and may produce a high-pitched noise during inhalation (stridor).

preoxygenation

The process of providing oxygen, often in combination with ventilation, prior to intubation in order to raise the oxygen levels of body tissues; a critical step in advanced airway management.

tonsil tips

Large, semi-rigid suction tips recommended for suctioning the pharynx.

diffusion

Movement of a gas from an area of higher concentration to an area of lower concentration.

oropharynx

A tubular structure that extends vertically from the back of the mouth to the esophagus and trachea.

ataxic respirations

Irregular, ineffective respirations that may or may not have an identifiable pattern.

parietal pleura

Thin membrane that lines the chest cavity.

labored breathing

The use of muscles of the chest, back, and abdomen to assist in expanding the chest; occurs when air movement is impaired.

anaerobic metabolism

Metabolism that takes place in the absence of oxygen; the main by-product is lactic acid.

nonrebreathing mask

A combination mask and reservoir bag system that is the preferred way to give oxygen in the prehospital setting; delivers up to 90% inspired oxygen and prevents inhaling the exhaled gases (carbon dioxide).

stridor

A harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope.

pulse oximetry

An assessment tool that measures oxygen saturation of hemoglobin in the capillary beds.

internal respiration

The exchange of gases between the blood cells and the tissues.

minute volume

The volume of air that moves in and out of the lungs per minute; calculated by multiplying the tidal volume and respiratory rate; also called minute ventilation.

oxygenation

The process of delivering oxygen to the blood by diffusion from the alveoli following inhalation into the lungs.

pneumothorax

An accumulation of air or gas in the pleural cavity.

capnography

A noninvasive method to quickly and efficiently provide information on a patient’s ventilatory status, circulation, and metabolism; effectively measures the concentration of carbon dioxide in expired air over time.

Cheyne-Strokes respirations

A cyclical pattern of abnormal breathing that increases and then decreases in rate and depth, followed by a period of apnea.

exhalation

The passive part of the breathing process in which the diaphragm and the intercostal muscles relax, forcing air out of the lungs.

apnea

Absence of spontaneous breathing.

airway

The upper tract or the passage above the larynx, which includes the nose, mouth, and throat.

bilateral

A body part or condition that appears on both sides of the midline.

hypoxic drive

A condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; seen in patients with chronic lung diseases.

pin-indexing system

A system established for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas.

residual volume

The air that remains in the lungs after maximal expiration.

visceral pleura

Thin membrane that covers the lungs.

tension pneumothorax

An accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest and that interferes with cardiac function, with potentially fatal results.

recovery position

A side-lying position used to maintain a clear airway in unresponsive patients who are breathing adequately and do not have suspected injuries to the spine, hips, or pelvis.

direct laryngoscopy

Visualization of the airway with a laryngoscope.

wheezing

A high-pitched, whistling breath sound that is most prominent on expiration, and which suggests an obstruction or narrowing of the lower airways; occurs in asthma and bronchiolitis.

oropharyngeal airway

Airway adjunct inserted into the mouth of an unresponsive patient to keep the tongue from blocking the upper airway and to facilitate suctioning the airway, if necessary.

severe airway obstruction

Occurs when a foreign body completely obstructs the patient’s airway. The patient cannot breathe, talk, or cough.

endotracheal intubation

Insertion of an endotracheal tube directly through the larynx between the vocal cords and into the trachea to maintain and protect an airway.

end-tidal CO2

The amount of carbon dioxide present at the end of an exhaled breath.

mediastinum

Space within the chest that contains the heart, major blood vessels, vagus nerve, trachea, major bronchi, and esophagus; located between the two lungs.

jaw-thrust maneuver

Technique to open the airway by placing the fingers behind the angle of the jaw and bringing the jaw forward; used for patients who may have a cervical spine injury.

aspiration

In the context of the airway, the introduction of vomitus or other foreign material into the lungs.

gum elastic bougie

A flexible device that is inserted between the glottis under direct laryngoscopy; the endotracheal tube is threaded over the device, facilitating its entry into the trachea.

partial pressure

The term used to describe the amount of gas in air or dissolved in fluid, such as blood.

chemoreceptors

Monitor the levels of oxygen, carbon dioxide, and pH of the cerebrospinal fluid and the provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body’s needs at any given time