Airway maintenance

The airway may become occluded by secretions, vomitus, blood, or foreign body. Reduced muscle tone in the obtunded patient may result in occlusion by the tongue and surrounding structures.

Opening the airway

• Clear secretions, vomitus, debris, or blood with a Yankauer sucker and/ or Magill’s forceps.

• In the absence of neck injury, and with the patient supine, tilt the head back with one hand on the forehead, and lift the chin with the fingers of the other hand.

• If there is a suspected neck injury or an inadequate airway with the head tilt and chin lift, perform a jaw thrust. With the patient supine, place the fingers behind the angle of the mandible on both sides and lift the mandible forward and upward until the lower teeth (or gum) are in front of the upper teeth (or gum).

Maintaining the airway

If the patient can be turned and is breathing adequately, it may suffi ce to adopt a lateral recovery position. If manual ventilation is required or the patient must remain supine, an oropharyngeal or nasopharyngeal airway may be used.

Oropharyngeal (Guedel) airway

• This is a hard plastic tube shaped to keep the tongue forward.

• It should only be used in obtunded patients.

• The correct size should be selected by comparing the airway to the distance between the teeth and the angle of the jaw.

• Open the patient’s mouth and remove any obstruction by suction.

• Insert the airway into the mouth with the curve pointing toward the skull.

• Rotate the airway through 180* once the soft palate is reached.

• The curve of the airway will retain its position in the oropharynx once fully inserted.

Nasopharyngeal airway

• This soft shaped plastic tube fi ts the passage from nares to pharynx.

• It is better tolerated in the semi-conscious patient, but should be avoided where there is a suspected/known basal skull fracture.

• Assess the correct size by approximating the diameter of the airway to the diameter of the patient’s fi fth fi nger.

• Insert a safety pin through the fl ange of the airway to prevent accidental inhalation after insertion.

• Pass the lubricated airway into the patent nostril with a slight twisting motion.