Skip to Main Content

++

Airway management is one of the most basic and important aspects of Emergency Medicine. The concepts and techniques described in this chapter can be applied to a variety of environments. Understanding the following concepts and having an opportunity to practice them will allow one to provide the most fundamental of all medical care, support of a patient’s airway.

++

Airway management is crucial. Without oxygen the brain begins to die within minutes.1 The primary purpose of airway management is to facilitate the transport of oxygen to the lungs. The secondary purpose is to protect the airway from contamination with blood, fluids, or food. Airway management can be as simple as lifting a snoring patient’s chin or as involved as awake fiberoptic-guided endotracheal intubation.

++

Time is always critical when a patient needs airway support. A healthy individual having maximally breathed 100% oxygen will begin to desaturate and have brain injury after 5 minutes of apnea. However, a sick patient breathing room air will desaturate almost immediately upon becoming apneic.1

++

The fundamental importance of airway management is reflected by the fact that two-thirds of Basic Life Support taught by the American Heart Association is concerned with this vital function.2The mission of airway management is “to ensure a patent airway, provide supplemental oxygen, and institute positive-pressure ventilation when spontaneous breathing is inadequate or absent.”3 These three key aspects of airway management warrant repeating. Ensure a patient airway. Provide supplemental oxygen. Provide positive-pressure ventilation.

++

Inadequate ventilation may occur for a variety of reasons. Spontaneously breathing patients may develop an airway obstruction due to food, blood, secretions, or tissue obstruction from the loss of the normal pharyngeal tone. Unconscious patients should have their airway secured as well as receiving mechanical ventilation. Despite spontaneous respiration, the unconscious patient is at risk for aspiration of gastric contents. The conscious patient with airway obstruction will be in obvious distress and is more likely to have obstruction due to a foreign body, tissue swelling from an infection, laryngeal edema, cancer, or laryngospasm.

++

The “airway” includes the nasal, oral, pharyngeal, and laryngeal anatomy and physiology. This highly complex system is responsible for conveying warmed and filtered air to the trachea and lungs while simultaneously allowing for passage of liquids and solids to the esophagus. Phonation is actually a secondary physiologic function of the larynx.4 This highly sophisticated system allows us to drink liquid, eat food, breathe, and talk simultaneously. However, if a small drop of liquid or a particle of food enters the airway, a profound system of reflexes is activated to protect its integrity.5

++

The nasal cavity and the nasopharynx is the area from the tip of the nose to the palate. It is highly innervated by the ophthalmic and maxillary branches of the trigeminal nerve. The mucosa of the nasal cavity and the nasopharynx is highly vascular. It is this high ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.