Chapter 5: Airway techniques

It is imperative to know the proper usage of the equipment and techniques necessary for the management of various cardiac problems and other medical emergencies. It is important to understand the head-tilt chin-lift maneuver for improving the patient’s airway ventilation. If person is choking: Look for foreign object and remove if you see it. If not and patient is in respiratory arrest, check for foreign object whenever you are giving rescue breaths. If no foreign object seen, continue CPR.

Airway Techniques Video:

Basic Airway Tools and Techniques

Oropharyngeal Airway (OPA): used in patients whose airway might be obstructed by the tongue or relaxed upper airway muscles. This device is only used in unconscious patients, but not in conscious or semiconscious patients where it could stimulate gagging or vomiting.

1. Ensure there is no blood or vomit in the pharynx by using the rigid pharyngeal suction
2. Find the proper size OPA by placing the OPA against the side of the patient’s face. The tip of the OPA should be at the corner of the mouth and the flange at the angle of the mandible
3. Insert the OPA as it curves upward towards the roof of the mouth
4. When the tip reaches the back of the tongue past the soft palate, rotate the airway 180 degrees so the tip is towards the throat
5. Push the airway slowly until the flange sits on the patient’s lips
   
   

Note: Use appropirate size for the OPA. OPAs that are too big will obstruct the larynx or may cause trauma. OPAs that are too small may push the tongue back and obstruct the airway.

Nasopharyngeal airway (NPA):  used as an alternative to OPAs and can be used in conscious or semiconscious patients. NPAs are usually inserted when inserting OPAs is difficult or dangerous.

1. Find the appropriate size NPA by checking the distance from the tip of the patient’s nose to the earlobe
2. Lubricate the airway
3. Put the airway through the nostril in a backwards direction toward the floor of the nasopharynx
   
   

Note: Use appropirate size for the NPA. Wrong size NPAs can go to the esophagus and cause gastric inflation. Be careful when inserting the airway as it can irritate the mucosa or lacerate the tissue.

Suctioning helps maintain a patient’s airway by removing secretions, blood or vomit.

1. Soft flexible catheters are used for the oropharynx and nasopharynx
2. Rigid catheters are used only for oropharynx
3. For oropharyngeal suctioning: measure the catheter by using the tip of the nose to the earlobe. Insert the catheter into the oropharynx right beyond the tongue.
4. For endotracheal tube suctioning: put the catheter into the ET tube making sure not to be beyond the ET tube. Suction should be no more than 10 seconds.
   
   

Learning Outcomes:

You have completed Course V. Now you should be able to:

1. Recognize the different airway devices
   1. Oropharngeal airway (OPA)
   2. Nasopharyngeal airway (NPA)
   3. Advanced airway
2. Understand the techniques in opening the airway