This document discusses airway assessment and management for an unconscious patient. It outlines maneuvers like head tilt-chin lift and jaw thrust to open the airway. Oropharyngeal and nasopharyngeal airways can help maintain a clear airway. Proper sizing and positioning of airways is important. Goals of emergency airway management are to ensure a patent airway, oxygenation, ventilation, and prevent aspiration.

1. Airway assessment and
management
FMOH
2013

2. Case scenario
A 28years old young man arrived to the ED after
1hr of fall down incident. On arrival patient
came on stretcher, non communicative, snoring,
responding only to pain, RR is 30/min, and
labored BP 100/60mmhg, P120/min, oxygen
saturation 80%,
– how do you approach to this patient

3. Con…
–List main clinical problems on this patient
–What maneuvers and equipment’s do you
use to manage this patient and why?
–List possible causes of the tachycardia?
– After 1hr stay in the ED patients BP,
dropped and became an recordable, describe
possible causes and your approach

4. Airway assessment &
management
skill that no health care worker should be
with out

5. • Insure open/patent airway
• Oxygenation
• Ventilation
• Prevent aspiration
Goals of Emergency Airway
Management

6. Signs of airway compromise
• Abnormal sounds: snoring, stridor
• Difficulty of breathing/dyspnea;
• Dysphasia – foreign body
• C hange in Skin color
• Agitation
• Loss of consciousness

7. Airway assessment of unconscious
pts
• Open the airway with manual maneuvers
• See for Presence of any foreign body or
secretions
• See whether the tong is falling back to
obstruct the airway
• See for any facial bone deformity
• Listen for any abnormal sounds during
breathings

8. Airways asss/mang.
• Head tilt –chin lift maneuver
• Jaw thrust maneuver

9. Head Tilt:
• The patient’s head is tilted backwards at the
atlanto-occipital joint on the neck and the
neck is hyper extended. This maneuver is
contraindicated in the presence of possible
cervical injury. After the head is extended,
functional obstruction is alleviated as the
epiglottis and tongue are elevated off the
posterior pharyngeal wall.

10. Jaw thrust
• is done by placing fingers at the angle of the
jaw and pull gently up and out. The procedure
moves away obstructing tongue from both the
palate and the posterior pharyngeal wall
• The jaw thrust without head tilt is the
technique of choice for a patient with a
suspected neck injury since it causes the least
amount of movement in the cervical spine.

11. Airway adjuvants
• Loss of upper airway muscle tone in anesthetized or
unconscious patients allows the tongue and epiglottis to
fall back against the posterior wall of the pharynx=>
airway obstruction
• Artificial Airways: Oropharyngeal or nasopharyngeal
airways help to maintain a clear airway by displacing the
tongue and other tissue from the posterior portion of the
hypo pharynx.

12. Oro and naso pharyngeal airways

13. oropharyngeal airway:
• Insert the airway with the tip facing up. Then rotate
the oral airway into position in the pharynx.
• Ensure that the patient is adequately anesthetized
or deeply unconscious, to prevent choking, coughing,
or gagging.
• Never force an oral airway into place. This may cause
trauma and bleeding. Alternatively, an oral airway
can be inserted tip down with the aid of a tongue
depressor.

14. Oro and naso pharyngeal airways

15. Oro-pharyngeal airway size
estimation

16. Oro and naso pharyngeal proper
position

17. nasal airway
• can be used in patients who has difficulty opening their
mouth. It should be lubricated and gently inserted.
• Do not force a nasal airway or a serious nosebleed may occur.
• Do not place a nasopharyngeal airway in patients with facial
or nasal fractures, anti coagulated patient and hypertrophied
tonsil.
• Placing a nasopharyngeal airway is not as stimulating as an
oral airway.
• The length of a nasal airway can be estimated as the distance
from the nares to the meatus of the ear, and should be
approximately 2 – 4 cm longer than oral airways.

18. Recovery position with
oropharyngeal airway

19. ?

20. Summery
• Address the aims of airway management:
patent airway, oxygenation, ventilation and
protection from aspiration
• Use proper hand maneuvers when
appropriate
• Proper choice of device, size and use of airway
adjuvants is very important
• Maintain recovery position in all unconscious
patients