Quick Facts

• Basic airway management ensures a patent airway and adequate ventilation in patients unable to maintain airway patency independently.

• Common techniques include head-tilt/chin-lift, jaw thrust, and use of airway adjuncts like oropharyngeal (OPA) and nasopharyngeal (NPA) airways.

• Bag-valve-mask (BVM) ventilation is a critical skill for providing positive pressure ventilation.

• Proper patient positioning and airway assessment are essential for effective airway management.

Procedure

Airway Assessment

• Check for airway patency: look for chest rise, listen for breath sounds, and feel for air movement.
• Identify signs of obstruction: gurgling, stridor, snoring, or silence.
• Assess for potential cervical spine injury before manipulating the airway.

Basic Airway Maneuvers

• Head-Tilt/Chin-Lift: Gently tilt the head back and lift the chin to open the airway. Avoid in suspected cervical spine injury.
• Jaw Thrust: Use when cervical spine injury is suspected. Lift the angles of the mandible forward without tilting the head.

Airway Adjuncts

• Oropharyngeal Airway (OPA): Inserted into the mouth to prevent the tongue from occluding the airway. Suitable for unconscious patients without a gag reflex.
• Nasopharyngeal Airway (NPA): Inserted into the nostril to maintain airway patency. Can be used in semi-conscious patients or when OPA is contraindicated. Contraindicated in nasal/midface fracture. Caution with those prone to nosebleeds (e.g. pregnant patients, on anticoagulants)

Bag-Valve-Mask (BVM) Ventilation

• Ensure a proper mask seal over the nose and mouth.
• Squeeze the bag gently to deliver breaths, observing chest rise and fall.
• Use supplemental oxygen when available to increase oxygen delivery.

Confirmation Steps

• Observe for adequate chest rise and fall with each ventilation.
• Listen for bilateral breath sounds and monitor oxygen saturation levels.
• Use capnography if available to assess ventilation effectiveness.

Documentation Requirements

• Record the airway management techniques used and patient response.
• Note the size and type of airway adjuncts inserted.
• Document oxygen delivery methods and patient oxygen saturation levels.

Scope Guide

References

1. StatPearls. Airway Management. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK470403/
2. AMBOSS. Airway Management. https://www.amboss.com/us/knowledge/airway-management/
3. EM Resident’s Guide to Basic Airway Management. https://coreem.net/core/an-em-residents-guide-to-basic-airway-management/