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
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
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 ...