Airway management

In a prehospital sector, airway obstruction or non-patent airway is certainly one of the major issues that each medical and trauma patients faceses world-wide or is a challenge that’s encountered by prehospital care providers. The goal of airway management is to offer sufficient ventilation as part of the general resuscitation effort, failure to provide it may lead to dying. As the patient will experience hypoxia and hypoxemia, hence resulting in organ and tissue failure. Certain methods are used to carry out this, head-tilt-chin lift and jaw-thrust maneuver and airway adjuncts are used to make the airway patent and makes it straightforward for patient ventilation with a bag valve masks.

Endotracheal intubation is the definitive methodology of airway administration compared to other methods, e.g. oropharyngeal and nasopharyngeal airway. In a health sector (prehospital) provision of airway management is completed according to scope of apply and sure protocols are to be adopted to prevent complications when managing airway. Indications embody decreased degree of consciousness, apnea, confusion due to hypoxia, cyanosis and obstruction to airway.

Considerations embody use of suctioning machines, electro-cardiogram monitor, defibrillator, medication full airway tools e.g oxygen masks, tank and other units used when managing airway.

THE THREE AXIS ALINGMENT

The three axis alignment principle is a method used to open an airway or be positive that the airway is patent enough to allow air air flow, it keeps the airway patent sufficient by aligning the oral axis, pharyngeal axis and the laryngeal axis. A Sniffing position can additionally be used to acquire this system.

A evaluation of the basic anesthesiology literature reveals a standard thread in the instructions for direct laryngoscopy: To efficiently visualize the larynx, one must align three (oral, laryngeal, and pharyngeal) anatomic axes.1-7 Placing a patient in the “sniffing position” is the accepted maneuver for aligning these axes. Recently, we evaluated a radiograph obtained during intubation within the sniffing position, drew strains along the axes (fig. 1), and didn’t observe this alignment. We then reviewed the literature to know the origin of this concept. The sniffing place has been credited to Chevalier Jackson in 1913, although he didn’t use this terminology or show alignment of the axes diagramatically. He merely advised that the affected person be positioned on a pillow in a natural place with the top extended.eight He went on to suggest that, in reality, the pillow might be eliminated, the thumbs positioned on the brow of the patient, and the brow vigorously compelled downward and backward, inflicting an anterior movement of the cranium on the atlas and throwing the cervical vertebrae forward.

After this proposal by Jackson, numerous authors provided their modifications of the method. However, the first (only?) authors to study the issue experimentally were Bannister and MacBeth,9 whose incessantly cited 1944 Lancet article graphically demonstrates the alignment of the three axes by use of an added pillow beneath the occiput, thus flexing the neck.9 The authors then propose that straightening the proper angle shaped by the axis of the mouth and the pharyngolaryngeal axis requires extension of the pinnacle on the atlantooccipital joint. They help their view with a series of drawings and radiographs. Although the authors’ drawings

illustrate plainly that the axes could also be brought into full alignment, shut examination of the radiographs reveals that the drawing did not coincide with the radiograph. Whereas the onerous palate is aligned with the larynx within the drawing, the angle of the larynx to the hard palate in the radiograph is roughly 36°. If one compares radiographs within the article, it turns into apparent that the laryngoscope proven in a single radiograph (patient in sniffing position) is not within the mouth. Otherwise this patient could be missing all of the upper incisors. Perhaps this is what was referred to previously within the article as “cooking” a diagram. In spite of this, the “three-axes rule” turned actuality.

It would appear to us that, though the sniffing position could provide the best laryngeal view, the explanation of the advantage of the sniffing position based mostly on alignment of the three axes is an error perpetuated since 1944 that deserves reexamination.

THE VORTEX APPROACH

The Vortex Approach is an airway administration technique which is used to familiarize clinicians with an approach to emergency airway management prior to the prevalence of an airway crisis. This technique provides steerage which predominantly directed at anaesthetists and is often restricted to the circumstance the place the first plan for the airway management is endotracheal intubation. The Vortex Approach, in contrast, relies around a “high acuity implementation”, particularly designed for use throughout excessive stakes, time critical state of affairs of an evolving airway emergency.

It is intended to assist medical groups carry out underneath strain by providing a sample, consistent template that may be taught to all clinicians involved in advanced airway administration, no matter critical care self-discipline and whether or not they’re from a medical, nursing or paramedical background, it is used at any context during which airway administration takes place. The Vortex implementation tool is predicated on the premise that there are solely three upper airway ‘lifelines’ (non-surgical techniques) by which alveolar oxygen delivery can be established and confirmed: face mask, supraglottic airway and endotracheal tube. If a ‘best effort’ at each of those three lifelines is unsuccessful then a can’t intubate, can’t oxygenate scenario (CICO) scenario exists and ‘CICO Rescue’ (emergency front-of-neck access) have to be initiated.

OROPHARYNGEAL AIRWAY ADJUNCT (OPA)

This is an airway adjunct used to hold up or open the airway by stopping the tongue from masking the epiglottis.

INDICATIONS OF OROPHARYNGEAL

• -used on sufferers with an absence of gag reflex or no gag reflex
• – sufferers with a low oxygen saturation reading

CONTRAINDICATIONS OF OROPHARYNGEAL

• -should not be used on acutely aware patients with an intact gag reflex
• -patient with nasal fractures and/or with lively bleeding
• -should not be used on sufferers who had suffered from oral trauma

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AVANTAGES OF OROPHARYNGEAL AIRWAY

• -able to protect the tongue from seizure activity
• -it is straightforward and quick to insert

DISADVANTAGES OF OROPHARYNGEAL AIRWAY

• -it might induce vomiting which may lead to aspiration
• -it could cause or worsen airway obstruction if an inappropriately sized airway is used (can cause laryngospasm)
• -can injury oral constructions if not used properly

NASOPHARYNGEAL AIRWAY (NPA)

This an airway adjunct designed to be inserted within the nasal cavity to maintain or maintain an airway patent or open for straightforward oxygenation of a patient.

INDICATIONS OF NASOPHARYNGEAL AIRWAY

• -used on conscious or semi-conscious patients with compromised airway
• -patients with intact gag reflex requiring airway management
• -patient with harm to the mouth or jaw, making it impossible to use the mouth as the primary passageway
• -patients with clenched tooth and unable to open mouth due to trauma, seizure and other medical conditions or poisoning

CONTRAINDICATIONS OF NASOPHARYNGEAL AIRWAY

• -patient with suspected cranium fracture
• -patient with blunt trauma to the top or face

ADVANTAGES OF NASOPHARYNGEAL AIRWAY

• -it is fast and simple to insert
• -can be used on patients who’ve mouth opening difficulty
• -can be used on semi-conscious and unconscious patients
• -provides air passage from the nose to pharynx by holding the tongue away from the pharynx

DISDAVANTAGES OF NASOPHARYNGEAL AIRWAY

• Should not be used on patients with sinus problems
• Should not be used on sufferers who susceptible to nose bleeding

ADVANCED AIRWAY ADJUCNTS

This are airway adjuncts that require more data and abilities to make use of, this includes endotracheal intubation and use of supraglottic device.

The use of an endotracheal tube require use of a laryngoscope since this is the most troublesome airway adjunct to insert and most safe airway adjunct out there, is the choice airway adjunct used by ALS (ADVANCED LIFE SUPPORT PARAMEDIC) As an EMT-A, am solely allowed to make use of laryngeal airway mask/supraglottic system as a end result of is the one advanced airway adjunct that I can use when managing airway in accordance with my scope of follow.

DIFFICULT AIRWAY ALGORITHM

Airway algorithm according to the American Society of Anesthesiologists

CONCLUSION

Airway obstruction is a worldwide downside, coping with it requires sure skills and techniques so as to keep it. Full understanding of anatomy and physiology of each higher and lower airways with the usage of airway adjuncts are needed when dealing with airway administration. Failure to understand or understand how they work or operate could result in complications which might to result in lack of life of a affected person. For a correct airway administration, the three axis alignment, the vortex method and the sniffing place are used in order to open the airway, the vortex strategy is used when there aren’t any enhancements in ventilation, different strategies of air flow are used I the vortex method till a patient is steady.