Discussion guide to Airways

Discussion guide to Airways

Anytime we talk about austere medicine, naturally airways come up, and for a variety of reasons. Just to catch up our audience we are going to cover a few basics, so everyone is on the same sheet of music. In this article we wont cover how and when to use a particular airway, but we rather discuss the intended use to hopefully clarify what item does what.

Anytime we talk about austere medicine, naturally airways come up, and for a variety of reasons. Just to catch up our audience we are going to cover a few basics, so everyone is on the same sheet of music. In this article we wont cover how and when to use a particular airway, but we rather discuss the intended use to hopefully clarify what item does what.

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Positional Airways. These are free, weigh nothing and often overlooked for sexier, more invasive techniques. A positional airway is exactly what it sounds like, position the patients airway or body in a way that keeps the tongue off the back of the throat, or prevents them from inhaling vomit. i.e. The sniffing position, or roll you patient onto their side AKA the "Frat Boy" or recovery position.

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Adjunct airways. Adjunct airways are temporary airways, that we put in place just to buy us a little time until we can do something a little more definitive. Although in many cases they are all that is needed or ever get used, they fall into the adjunct category simply because better airways are available to skilled providers.

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NPAs or nasal pharyngeal airways. The correct term is NPA but its ok if you call it a nasal trumpet. An NPA is designed to go thru the nasal passage and sit just behind the tongue and keep your patients airway open, essentially keep them from snoring. In order for these to work they have to be sized correctly for the patient before placement. Make sure you keep a variety of sizes handy, I see in training people who just go thru the motions of sizing them up..... These are uncomfortable for the patient but should avoid the gag reflex.

NPA

OPAs or Oral Pharyngeal airways. The correct term is OPA but if you want to call them a J-Tube that's fine as well. OPAs are large, smooth J shaped pipes are bridges that go thru the mouth and lift the tongue off the back of the throat. This will stimulate a gag reflex and they also fall out a easier than an NPA. Its for that reason NPAs tend to be the go to adjunct airway in the field. OPAs will pass more air in most cases, so EMS folks tend to prefer the OPA because it fits in a little better with other treatments they may do later as a provider. [gallery size="medium" link="none" orderby="rand" ids="2543,2542,2544"] Supraglottic Airways (Above the glottis AKA the air flap). I tend to categorize Supraglottic airways between an adjunct and a definitive airway like intubation or crics (we will explain). These airways are designed to go "Blindly" into the back of the throat and isolate the OPENING of the trachea, by either blocking off the esophagus, as in the case of the King Lt. or by chance actually landing in the trachea proper by chance as in the case of a Combitube which does both depending on where it lands.

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Supraglottic airways are procedurally easier than crics and intubation, but are still not considered definitve by most because they do NOT isolate the trachea. The right Supraglottic airway works well enough for anesthesia so they have the chops to save lives, but tend to be priced out the everyday persons IFAK. I like the KING LT by North American Rescue, its as close to Infantry proof as you can get while giving you operating room level performance. [gallery ids="2545,2546,2547" orderby="rand"] Definitive Airways. The goal of most providers is to isolate the trachea, this increases the effectiveness of any treatments they provide and reduces the risk of vomit or any other nasty's getting into the airway. If you ever get to watch an ER run a "mega code", you will notice a sigh of relief once the patient is "tubed" Surgical Airways. This is the first of two definitive airways we will discuss in this article. I've placed these just above the supraglottics, but frankly they are a teachable skill to the laymen provider. I've taught many an operator how to cric, and they have performed the procedure well. The only surgical airway we are concerned about in the field is the CricoThyroidotomy, or "Cric". With out getting into specifics you go in thru a small incision at the base of the Adams apple and slide a tube INTO the trachea. the tube should have an inflatable cuff on the end, so that when you inflate the cuff, gas must pass in and out the tube alone, and fluids cant get into the lungs. This technique bypasses the gag reflex altogether and is a great option for providers dealing with a potentially ugly airway combined with a head injury or disembowelment. This procedure is generally considered safe, im a fan of teaching it to dedicated responders but ill leave that discussion to people with letters behind their name. [gallery size="medium" ids="2548,2549"] Intubation. The gold standard for airways. Using a specialized scope and a properly sized cuffed tube, the provider slides a ET (Endotracheal) Tube directly into the trachea, and when they inflate the cuff they isolate the trachea the same as the cric we mentioned before. This requires a great amount of technique and experience, even seasoned paramedics dread having to do this in the field. A lot can go wrong and we certainly wouldn't recommend this to a laymen. Its good to know about this procedure even if you cant "tube" someone yourself. Ultimately this is where you patient is going if his level of consciousness allows it. This skill is generally for paramedic level providers and above and for good reason. It is entirely possible to use a modified version of this procedure and go thru the nose, but again it requires some skill and clinical hours to learn. [gallery columns="4" ids="2550,2551,2552,2553" orderby="rand"] Certainly there are a myriad of factors that will guide your decision on what to use and when, but that's not for this article. Consider:

  • Pediatrics
  • Individual anatomy
  • Spinal Injuries
  • Head injuries
  • Mass casualties scenarios

In the CAG tier 1 Med Kit we have a variety of positional airways and an NPA. Keep in mind the key to good airway management is a rock solid assessment. Here at Crisis Application Group we teach MARCH (The science is in the sequence) using what ever airway exam your competent in. and make sure to slow down for at least 5 seconds when look listen and feel. Of course if you have any questions hit us up on Facebook and as always thank you. [caption id="attachment_2314" align="aligncenter" width="654"]cagnet GREEN BERET MODERATED FORUM[/caption]

Last modified onTuesday, 07 November 2017 02:31

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