Airway management: Difference between revisions
Major revision - added new section on airway management in specific situations such as cpr, removed old section on cpr (out of date info), reorganised invasive airways, added supraglottic section. Work in progress, comments welcome. |
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==Airway maneuvers== |
==Airway maneuvers== |
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===Head-tilt chin-lift=== |
===Head-tilt chin-lift=== |
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[[Image:Tongue-blocking-airways.png|thumb|The head-tilt chin-lift is the most reliable method of opening the airway.]]'''Head-tilt chin-lift''' — The head-tilt chin-lift is the primary maneuver used in any patient in whom [[cervical spine]] injury is not a concern. The simplest way of ensuring an open airway in an unconscious patient is to use a head tilt chin lift technique, thereby lifting the tongue from the back of the throat. This is taught on most [[first aid]] courses as the standard way of clearing an airway. |
[[Image:Tongue-blocking-airways.png|thumb|The head-tilt chin-lift is the most reliable method of opening the airway.]]'''Head-tilt chin-lift''' — The head-tilt chin-lift is the primary maneuver used in any patient in whom [[cervical spine]] injury is not a concern. The simplest way of ensuring an open airway in an unconscious patient is to use a head tilt chin lift technique, thereby lifting the tongue from the back of the throat. This is taught on most [[first aid]] courses as the standard way of clearing an airway. |
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===Jaw-thrust maneuver=== |
===Jaw-thrust maneuver=== |
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'''Jaw-thrust maneuver''' — The jaw-thrust maneuver is an effective airway technique, particularly in the patient in whom cervical spine injury is a concern. The jaw thrust is a technique used on patients with a suspected [[spinal injury]] and is used on a [[supine position|supine]] patient. The practitioner uses their |
'''Jaw-thrust maneuver''' — The jaw-thrust maneuver is an effective airway technique, particularly in the patient in whom cervical spine injury is a concern. The jaw thrust is a technique used on patients with a suspected [[spinal injury]] and is used on a [[supine position|supine]] patient. The practitioner uses their index and middle fingers to physically push the posterior (back) aspects of the mandible upwards while their thumbs push down on the chin to open the mouth. When the mandible is displaced forward, it pulls the tongue forward and prevents it from occluding (blocking) the entrance to the [[Vertebrate trachea|trachea]], helping to ensure a patent (secure) airway. |
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The [[ILCOR|International Liaison Committee on Resuscitation]] no longer advocates use of the jaw thrust by lay rescuers,<ref>[http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-5 Part 2: Adult Basic Life Support - 112 (22 Supplement): III-5 - Circulation<!-- Bot generated title -->]</ref> even for spinal-injured victims, although health care professionals still maintain the technique for specific applications. Instead, lay rescuers are advised to use the same head-tilt for all victims. |
The [[ILCOR|International Liaison Committee on Resuscitation]] no longer advocates use of the jaw thrust by lay rescuers,<ref>[http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-5 Part 2: Adult Basic Life Support - 112 (22 Supplement): III-5 - Circulation<!-- Bot generated title -->]</ref>{{failed verification|date=June 2013}} even for spinal-injured victims, although health care professionals still maintain the technique for specific applications. Instead, lay rescuers are advised to use the same head-tilt for all victims. |
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===Cervical spine immobilization=== |
===Cervical spine immobilization=== |
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'''Cervical spine immobilization''' — Most airway maneuvers are associated with some movement of the [[cervical spine]] (c-spine).<ref name="pmid9201858">{{cite journal| author=Donaldson WF, Heil BV, Donaldson VP, Silvaggio VJ| title=The effect of airway maneuvers on the unstable C1-C2 segment. A cadaver study. | journal=Spine (Phila Pa 1976) | year= 1997 | volume= 22 | issue= 11 | pages= 1215–8 | pmid=9201858 | doi= | pmc= | url= }}</ref><ref name="pmid11049921">{{cite journal| author=Brimacombe J, Keller C, Künzel KH, Gaber O, Boehler M, Pühringer F| title=Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers |
'''Cervical spine immobilization''' — Most airway maneuvers are associated with some movement of the [[cervical spine]] (c-spine).<ref name="pmid9201858">{{cite journal| author=Donaldson WF, Heil BV, Donaldson VP, Silvaggio VJ| title=The effect of airway maneuvers on the unstable C1-C2 segment. A cadaver study. | journal=Spine (Phila Pa 1976) | year= 1997 | volume= 22 | issue= 11 | pages= 1215–8 | pmid=9201858 | doi= 10.1097/00007632-199706010-00008| pmc= | url= }}</ref><ref name="pmid11049921">{{cite journal| author=Brimacombe J, Keller C, Künzel KH, Gaber O, Boehler M, Pühringer F| title=Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers | journal=Anesth Analg | year= 2000 | volume= 91 | issue= 5 | pages= 1274–8 | pmid=11049921 | doi= | pmc= | url= }}</ref> Even though collars for holding the head in-line can cause problems maintaining an airway and maintaining a blood pressure,<ref name="pmid10102310">{{cite journal| author=Kolb JC, Summers RL, Galli RL| title=Cervical collar-induced changes in intracranial pressure | journal=Am J Emerg Med | year= 1999 | volume= 17 | issue= 2 | pages= 135–7 | pmid=10102310 | doi= 10.1016/S0735-6757(99)90044-X| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10102310 }}</ref> it is unrecommended to remove the collar without adequate personnel to manually hold the head in place.<ref name="pmid12121154">{{cite journal| author=Mobbs RJ, Stoodley MA, Fuller J| title=Effect of cervical hard collar on intracranial pressure after head injury | journal=ANZ J Surg | year= 2002 | volume= 72 | issue= 6 | pages= 389–91 | pmid=12121154 | doi= 10.1046/j.1445-2197.2002.02462.x| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12121154 }}</ref> |
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== Invasive airway management == |
== Invasive airway management == |
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===Oropharyngeal airway=== |
===Oropharyngeal airway=== |
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{{Main|Oropharyngeal airway}} |
{{Main|Oropharyngeal airway}} |
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[[File:Oropharyngeal Airways.jpg|thumb|right|Oropharyngeal airways in a range of sizes]] |
[[File:Oropharyngeal Airways.jpg|thumb|right|Oropharyngeal airways in a range of sizes]] |
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'''Oropharyngeal airway''' — Oropharyngeal airways (OPA) (also known as Guedel airways)<ref>Guedel A. E. J. Am. Med. Assoc. 1933, 100, 1862 (reprinted in “Classical File”, Survey of Anesthesiology 1966,10, 515)</ref> are rigid plastic curved devices used to hold tissue (such as the tongue) away from the airway to keep it open. An OPA should only be used in a deeply unresponsive patient because in a responsive patient they can cause vomiting and aspiration by stimulating the [[Pharyngeal reflex|gag reflex]].<ref name=anaUK2010>{{cite web|title=Guedel airway|url=http://www.frca.co.uk/article.aspx?articleid=101120|work=AnaesthesiaUK|accessdate=23 May 2013|date=14|month=05|year=2010}}</ref> |
'''Oropharyngeal airway''' — Oropharyngeal airways (OPA) (also known as Guedel airways)<ref>Guedel A. E. J. Am. Med. Assoc. 1933, 100, 1862 (reprinted in “Classical File”, Survey of Anesthesiology 1966,10, 515)</ref> are rigid plastic curved devices used to hold tissue (such as the tongue) away from the airway to keep it open. An OPA should only be used in a deeply unresponsive patient because in a responsive patient they can cause vomiting and aspiration by stimulating the [[Pharyngeal reflex|gag reflex]].<ref name=anaUK2010>{{cite web|title=Guedel airway|url=http://www.frca.co.uk/article.aspx?articleid=101120|work=AnaesthesiaUK|accessdate=23 May 2013|date=14|month=05|year=2010}}</ref> |
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===Nasopharyngeal airway=== |
===Nasopharyngeal airway=== |
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{{Main|Nasopharyngeal airway}} |
{{Main|Nasopharyngeal airway}} |
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[[File:USMC-080531-M-8776A-001.jpg|thumb|right|Learning to insert a nasopharyngeal airway]] |
[[File:USMC-080531-M-8776A-001.jpg|thumb|right|Learning to insert a nasopharyngeal airway]] |
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'''Nasopharyngeal airway''' — The nasopharyngeal airway (NPA) (also known as a nasal trumpet) is a soft rubber or plastic hollow tube that is passed through the nose into the posterior pharynx. Patients tolerate NPAs more easily than OPAs, so NPAs can be used when the use of an OPA is difficult, such as when the patient's jaw is clenched or the patient is semiconscious and cannot tolerate an OPA.<ref name="pmid15911941">{{cite journal| author=Roberts K, Whalley H, Bleetman A| title=The nasopharyngeal airway: dispelling myths and establishing the facts |
'''Nasopharyngeal airway''' — The nasopharyngeal airway (NPA) (also known as a nasal trumpet) is a soft rubber or plastic hollow tube that is passed through the nose into the posterior pharynx. Patients tolerate NPAs more easily than OPAs, so NPAs can be used when the use of an OPA is difficult, such as when the patient's jaw is clenched or the patient is semiconscious and cannot tolerate an OPA.<ref name="pmid15911941">{{cite journal| author=Roberts K, Whalley H, Bleetman A| title=The nasopharyngeal airway: dispelling myths and establishing the facts | journal=Emerg Med J | year= 2005 | volume= 22 | issue= 6 | pages= 394–6 | pmid=15911941 | doi=10.1136/emj.2004.021402 | pmc=1726817 }}</ref> NPAs are generally not recommended if there is suspicion of a fracture to the base of the skull, due to the possibility of the tube entering the cranium.<ref name=EMJ2006>{{Cite doi|10.1136/emj.2006.036541}}</ref> However, the actual risks of this complication occurring compared to the risks of damage from hypoxia if an airway is not used are debatable.<ref name=EMJ2006/><ref name=EMJ2004>{{Cite doi|10.1136/emj.2004.021402}}</ref> |
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===Supraglottic airway=== |
===Supraglottic airway=== |
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{{Main|Laryngeal mask airway}} |
{{Main|Laryngeal mask airway}} |
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[[File:ProSeal Laryngeal Mask Airway inflated 001.jpg|thumb|right|ProSeal Laryngeal Mask Airway inflated 001]] |
[[File:ProSeal Laryngeal Mask Airway inflated 001.jpg|thumb|right|ProSeal Laryngeal Mask Airway inflated 001]] |
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Supraglottic airways (also called extraglottic<ref name=Hernandez2011>{{cite journal|first=MR|last=Hernandez|first2=A|last2=Klock|first3=A|last3=Ovassapian|title=Evolution of the Extraglottic Airway: A Review of Its History, Applications, and Practical Tips for Success|journal=Anesthesia and Analgesia|volume=114|issue=2|pages=349–68|year=2011|doi=10.1213/ |
Supraglottic airways (also called extraglottic<ref name=Hernandez2011>{{cite journal|first=MR|last=Hernandez|first2=A|last2=Klock|first3=A|last3=Ovassapian|title=Evolution of the Extraglottic Airway: A Review of Its History, Applications, and Practical Tips for Success|journal=Anesthesia and Analgesia|volume=114|issue=2|pages=349–68|year=2011|doi=10.1213/ANE.0b013e31823b6748|pmid=22178627}}</ref>) are a family of devices that are inserted through the mouth to sit on top of the larynx. The most well known example is the Laryngeal Mask Airway (LMA). Other variations include devices with oesophageal access ports, so that a separate tube can be inserted from the mouth to the stomach to decompress accumulated gases and drain liquid contents.<ref name=Hernandez2011 /> Some devices can have an endotracheal tube passed through them into the trachea (intubating LMA).<ref name=Hernandez2011 /> |
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| ⚫ | Supraglottic airways are used in the majority of operations performed under general anaesthesia.<ref name=Cook2010>{{cite journal|last=Cook|first=T|title=Supraglottic airway devices: recent advances|journal=Continuing Education in Anaesthesia, Critical Care and Pain |year=2010|doi=10.1093/bjaceaccp/mkq058|last2=Howes|first2=B.|volume=11|issue=2|pages=56}}</ref> Compared to a cuffed tracheal tube (see below), they give less protection against aspiration but are easier to insert and cause less laryngeal trauma.<ref name=Hernandez2011 /> |
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| ⚫ | Supraglottic airways are used in the majority of operations performed under general anaesthesia.<ref name=Cook2010>{{cite journal|last=Cook|first=T|title=Supraglottic airway devices: recent advances|journal=Continuing Education in Anaesthesia, Critical Care and Pain |year=2010|doi=10.1093/bjaceaccp/mkq058}}</ref> Compared to a cuffed tracheal tube (see below), they give less protection against aspiration but are easier to insert and cause less laryngeal trauma.<ref name=Hernandez2011 /> |
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===Tracheal intubation=== |
===Tracheal intubation=== |
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{{Main|Tracheal intubation}} |
{{Main|Tracheal intubation}} |
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[[File:Intubasion boru.jpg|thumb|right|A cuffed endotracheal tube used in tracheal intubation]] |
[[File:Intubasion boru.jpg|thumb|right|A cuffed endotracheal tube used in tracheal intubation]] |
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Tracheal intubation, |
Tracheal intubation, often simply referred to as '''[[intubation]]''', is the placement of a flexible plastic or rubber [[catheter|tube]] into the [[vertebrate trachea|trachea]] (windpipe) to maintain an open [[airway]] or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill or anesthetized patients to facilitate [[Ventilation (physiology)|ventilation]] of the lungs, including [[mechanical ventilation]], and to prevent the possibility of [[asphyxia]]tion or airway obstruction. The most widely used route is orotracheal, in which an [[tracheal tube|endotracheal tube]] is passed through the mouth and [[larynx|vocal apparatus]] into the trachea. In a nasotracheal procedure, an endotracheal tube is passed through the nose and vocal apparatus into the trachea. |
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===Cricothyrotomy=== |
===Cricothyrotomy=== |
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===Tracheotomy=== |
===Tracheotomy=== |
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{{Main|Tracheostomy}} |
{{Main|Tracheostomy}} |
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[[File:Tracheostomy tube.jpg|thumb|right|A cuffed |
[[File:Tracheostomy tube.jpg|thumb|right|A cuffed [[tracheostomy tube]] used in tracheal intubation through a tracheostoma]] |
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A '''Tracheotomy''' is a surgically created opening from the skin of the neck down to the trachea (windpipe).<ref name=Silva2012>{{Cite doi|10.1002/14651858.CD007271.pub2}}</ref> A tracheotomy may be considered where a person will need to be on a mechanical ventilator for a long time.<ref name=Silva2012/> The advantages of a tracheotomy include less risk of infection and damage to the trachea such as tracheal stenosis.<ref name=Silva2012/> |
A '''Tracheotomy''' is a surgically created opening from the skin of the neck down to the trachea (windpipe).<ref name=Silva2012>{{Cite doi|10.1002/14651858.CD007271.pub2}}</ref> A tracheotomy may be considered where a person will need to be on a mechanical ventilator for a long time.<ref name=Silva2012/> The advantages of a tracheotomy include less risk of infection and damage to the trachea such as tracheal stenosis.<ref name=Silva2012/> |
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==Removal of vomit and regurgitation== |
==Removal of vomit and regurgitation== |
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In the case of a patient who [[vomiting|vomit]]s or has other secretions in the airway, these techniques will not be enough. Suitably trained clinicians may elect to use suction to clean out the airway, although this may not always be possible. |
In the case of a patient who [[vomiting|vomit]]s or has other secretions in the airway, these techniques will not be enough. Suitably trained clinicians may elect to use suction to clean out the airway, although this may not always be possible. An unconscious patient who is regurgitating stomach contents should be turned into the [[recovery position]] when there is no suction equipment available, as this allows (to a certain extent) the drainage of fluids out of the mouth instead of down the trachea. |
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==Airway management in specific situations== |
==Airway management in specific situations== |
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===Cardiopulmonary resuscitation=== |
===Cardiopulmonary resuscitation=== |
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{{Main|Cardiopulmonary resuscitation}} |
{{Main|Cardiopulmonary resuscitation}} |
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The best method of airway management during CPR is controversial.<ref name=Soar2013>{{Cite doi|10.1097/MCC.0b013e328360ac5e}}</ref> There has been less emphasis on airway management (including simple mouth-to-mouth or invasive methods) during CPR, since it was shown that people receiving initial chest-compression-only CPR were more likely to survive than those who had standard CPR.<ref name=Soar2013 /> People who are resuscitated with basic bag-mask ventilation may also be more likely to survive than those who are intubated or have a supraglottic airway inserted.<ref name=Soar2013 /> However, in children, or where the cause of the arrest was an airway or breathing problem, or where the arrest is prolonged, airway management is still important.<ref name=Soar2013 /> |
The best method of airway management during CPR is controversial.<ref name=Soar2013>{{Cite doi|10.1097/MCC.0b013e328360ac5e}}</ref> There has been less emphasis on airway management (including simple mouth-to-mouth or invasive methods) during CPR, since it was shown that people receiving initial chest-compression-only CPR were more likely to survive than those who had standard CPR.<ref name=Soar2013 /> People who are resuscitated with basic bag-mask ventilation may also be more likely to survive than those who are intubated or have a supraglottic airway inserted.<ref name=Soar2013 /> However, in children, or where the cause of the arrest was an airway or breathing problem, or where the arrest is prolonged, airway management is still important.<ref name=Soar2013 /> |
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In basic life support, many people can be reluctant to start [[Artificial respiration|mouth-to-mouth resuscitation]].<ref name=Sayre2008>{{Cite doi|10.1161/CIRCULATIONAHA.107.189380}}</ref> The [[American Heart Association]] now supports "Hands-only"™ CPR, which advocates chest compressions without any airway management for teens or adults.<ref name=Sayre2008/> Bystanders who see an adult suddenly collapse should call for help and move to chest compressions straight away.<ref name=Sayre2008/> It is likely that later in resuscitation care by trained professionals, simple methods as well as supraglottic and tracheal airways each have a role, depending on the skills of the person performing them and the equipment or environment they are working in.<ref name= |
In basic life support, many people can be reluctant to start [[Artificial respiration|mouth-to-mouth resuscitation]].<ref name=Sayre2008>{{Cite doi|10.1161/CIRCULATIONAHA.107.189380}}</ref> The [[American Heart Association]] now supports "Hands-only"™ CPR, which advocates chest compressions without any airway management for teens or adults.<ref name=Sayre2008/> Bystanders who see an adult suddenly collapse should call for help and move to chest compressions straight away.<ref name=Sayre2008/> It is likely that later in resuscitation care by trained professionals, simple methods as well as supraglottic and tracheal airways each have a role, depending on the skills of the person performing them and the equipment or environment they are working in.<ref name=Hernandez2011 /><ref name=Soar2013 /> |
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===Trauma=== |
===Trauma=== |
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In prehospital environments, airway management is controversial, with intubation and supraglottic airways each having advantages and disadvantages. Trauma victims are often not fasting so there is an increased risk of aspiration, but blood and other material may make it difficult to see the larynx to intubate.<ref name=Hernandez2011 /> |
In prehospital environments, airway management is controversial, with intubation and supraglottic airways each having advantages and disadvantages. Trauma victims are often not fasting so there is an increased risk of aspiration, but blood and other material may make it difficult to see the larynx to intubate.<ref name=Hernandez2011 /> |
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==See also== |
==See also== |
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*[[Tracheal intubation]] |
*[[Tracheal intubation]] |
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| ⚫ | |||
*[[Laryngeal mask airway]] |
*[[Laryngeal mask airway]] |
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*[[Laryngeal tube]] |
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*[[Combitube]] |
*[[Combitube]] |
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| ⚫ | |||
*[[Ventilation (physiology)|Ventilation]] |
*[[Ventilation (physiology)|Ventilation]] |
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*[[Cardioversion]] |
*[[Cardioversion]] |
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Revision as of 00:17, 10 June 2013
 | It has been suggested that Artificial airway be merged into this article. (Discuss) Proposed since May 2013. |
| Airway management | |
|---|---|
| MeSH | D058109 |
Airway management is the medical process of ensuring there is an open pathway between a patient’s lungs and the outside world, as well as reducing the risk of aspiration. Airway management is a primary consideration in cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid.
Airway maneuvers
Head-tilt chin-lift
Head-tilt chin-lift — The head-tilt chin-lift is the primary maneuver used in any patient in whom cervical spine injury is not a concern. The simplest way of ensuring an open airway in an unconscious patient is to use a head tilt chin lift technique, thereby lifting the tongue from the back of the throat. This is taught on most first aid courses as the standard way of clearing an airway.
Jaw-thrust maneuver
Jaw-thrust maneuver — The jaw-thrust maneuver is an effective airway technique, particularly in the patient in whom cervical spine injury is a concern. The jaw thrust is a technique used on patients with a suspected spinal injury and is used on a supine patient. The practitioner uses their index and middle fingers to physically push the posterior (back) aspects of the mandible upwards while their thumbs push down on the chin to open the mouth. When the mandible is displaced forward, it pulls the tongue forward and prevents it from occluding (blocking) the entrance to the trachea, helping to ensure a patent (secure) airway.
The International Liaison Committee on Resuscitation no longer advocates use of the jaw thrust by lay rescuers,[1][failed verification] even for spinal-injured victims, although health care professionals still maintain the technique for specific applications. Instead, lay rescuers are advised to use the same head-tilt for all victims.
Cervical spine immobilization
Cervical spine immobilization — Most airway maneuvers are associated with some movement of the cervical spine (c-spine).[2][3] Even though collars for holding the head in-line can cause problems maintaining an airway and maintaining a blood pressure,[4] it is unrecommended to remove the collar without adequate personnel to manually hold the head in place.[5]
Invasive airway management
Oropharyngeal airway
Oropharyngeal airway — Oropharyngeal airways (OPA) (also known as Guedel airways)[6] are rigid plastic curved devices used to hold tissue (such as the tongue) away from the airway to keep it open. An OPA should only be used in a deeply unresponsive patient because in a responsive patient they can cause vomiting and aspiration by stimulating the gag reflex.[7]
Nasopharyngeal airway
Nasopharyngeal airway — The nasopharyngeal airway (NPA) (also known as a nasal trumpet) is a soft rubber or plastic hollow tube that is passed through the nose into the posterior pharynx. Patients tolerate NPAs more easily than OPAs, so NPAs can be used when the use of an OPA is difficult, such as when the patient's jaw is clenched or the patient is semiconscious and cannot tolerate an OPA.[8] NPAs are generally not recommended if there is suspicion of a fracture to the base of the skull, due to the possibility of the tube entering the cranium.[9] However, the actual risks of this complication occurring compared to the risks of damage from hypoxia if an airway is not used are debatable.[9][10]
Supraglottic airway
Supraglottic airways (also called extraglottic[11]) are a family of devices that are inserted through the mouth to sit on top of the larynx. The most well known example is the Laryngeal Mask Airway (LMA). Other variations include devices with oesophageal access ports, so that a separate tube can be inserted from the mouth to the stomach to decompress accumulated gases and drain liquid contents.[11] Some devices can have an endotracheal tube passed through them into the trachea (intubating LMA).[11]
Supraglottic airways are used in the majority of operations performed under general anaesthesia.[12] Compared to a cuffed tracheal tube (see below), they give less protection against aspiration but are easier to insert and cause less laryngeal trauma.[11]
Tracheal intubation
Tracheal intubation, often simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction. The most widely used route is orotracheal, in which an endotracheal tube is passed through the mouth and vocal apparatus into the trachea. In a nasotracheal procedure, an endotracheal tube is passed through the nose and vocal apparatus into the trachea.
Cricothyrotomy
A cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial trauma.[13] A cricothyrotomy is nearly always performed as a last resort in cases where orotracheal and nasotracheal intubation are impossible or contraindicated. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine and is associated with fewer complications.[14]]
Tracheotomy
A Tracheotomy is a surgically created opening from the skin of the neck down to the trachea (windpipe).[15] A tracheotomy may be considered where a person will need to be on a mechanical ventilator for a long time.[15] The advantages of a tracheotomy include less risk of infection and damage to the trachea such as tracheal stenosis.[15]
Removal of vomit and regurgitation
In the case of a patient who vomits or has other secretions in the airway, these techniques will not be enough. Suitably trained clinicians may elect to use suction to clean out the airway, although this may not always be possible. An unconscious patient who is regurgitating stomach contents should be turned into the recovery position when there is no suction equipment available, as this allows (to a certain extent) the drainage of fluids out of the mouth instead of down the trachea.
Airway management in specific situations
Cardiopulmonary resuscitation
The best method of airway management during CPR is controversial.[16] There has been less emphasis on airway management (including simple mouth-to-mouth or invasive methods) during CPR, since it was shown that people receiving initial chest-compression-only CPR were more likely to survive than those who had standard CPR.[16] People who are resuscitated with basic bag-mask ventilation may also be more likely to survive than those who are intubated or have a supraglottic airway inserted.[16] However, in children, or where the cause of the arrest was an airway or breathing problem, or where the arrest is prolonged, airway management is still important.[16]
In basic life support, many people can be reluctant to start mouth-to-mouth resuscitation.[17] The American Heart Association now supports "Hands-only"™ CPR, which advocates chest compressions without any airway management for teens or adults.[17] Bystanders who see an adult suddenly collapse should call for help and move to chest compressions straight away.[17] It is likely that later in resuscitation care by trained professionals, simple methods as well as supraglottic and tracheal airways each have a role, depending on the skills of the person performing them and the equipment or environment they are working in.[11][16]
Trauma
In prehospital environments, airway management is controversial, with intubation and supraglottic airways each having advantages and disadvantages. Trauma victims are often not fasting so there is an increased risk of aspiration, but blood and other material may make it difficult to see the larynx to intubate.[11]
See also
- Tracheal intubation
- Laryngeal mask airway
- Laryngeal tube
- Combitube
- Endotracheal tube
- Ventilation
- Cardioversion
References
- ^ Part 2: Adult Basic Life Support - 112 (22 Supplement): III-5 - Circulation
- ^ Donaldson WF, Heil BV, Donaldson VP, Silvaggio VJ (1997). "The effect of airway maneuvers on the unstable C1-C2 segment. A cadaver study". Spine (Phila Pa 1976). 22 (11): 1215–8. doi:10.1097/00007632-199706010-00008. PMID 9201858.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Brimacombe J, Keller C, Künzel KH, Gaber O, Boehler M, Pühringer F (2000). "Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers". Anesth Analg. 91 (5): 1274–8. PMID 11049921.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Kolb JC, Summers RL, Galli RL (1999). "Cervical collar-induced changes in intracranial pressure". Am J Emerg Med. 17 (2): 135–7. doi:10.1016/S0735-6757(99)90044-X. PMID 10102310.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Mobbs RJ, Stoodley MA, Fuller J (2002). "Effect of cervical hard collar on intracranial pressure after head injury". ANZ J Surg. 72 (6): 389–91. doi:10.1046/j.1445-2197.2002.02462.x. PMID 12121154.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Guedel A. E. J. Am. Med. Assoc. 1933, 100, 1862 (reprinted in “Classical File”, Survey of Anesthesiology 1966,10, 515)
- ^ "Guedel airway". AnaesthesiaUK. 14. Retrieved 23 May 2013.
{{cite web}}: Check date values in:|date=and|year=/|date=mismatch (help); Unknown parameter|month=ignored (help) - ^ Roberts K, Whalley H, Bleetman A (2005). "The nasopharyngeal airway: dispelling myths and establishing the facts". Emerg Med J. 22 (6): 394–6. doi:10.1136/emj.2004.021402. PMC 1726817. PMID 15911941.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ a b Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1136/emj.2006.036541, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with
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|doi=10.1136/emj.2004.021402instead. - ^ a b c d e f Hernandez, MR; Klock, A; Ovassapian, A (2011). "Evolution of the Extraglottic Airway: A Review of Its History, Applications, and Practical Tips for Success". Anesthesia and Analgesia. 114 (2): 349–68. doi:10.1213/ANE.0b013e31823b6748. PMID 22178627.
- ^ Cook, T; Howes, B. (2010). "Supraglottic airway devices: recent advances". Continuing Education in Anaesthesia, Critical Care and Pain. 11 (2): 56. doi:10.1093/bjaceaccp/mkq058.
- ^ Mohan, R; Iyer, R; Thaller, S (2009). "Airway management in patients with facial trauma". Journal of Craniofacial Surgery. 20 (1): 21–3. doi:10.1097/SCS.0b013e318190327a. PMID 19164982.
- ^ Katos, MG; Goldenberg, D (2007). "Emergency cricothyrotomy". Operative Techniques in Otolaryngology. 18 (2): 110–4. doi:10.1016/j.otot.2007.05.002.
- ^ a b c Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1002/14651858.CD007271.pub2, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with
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Emergency Medical Responder (Second Canadian Version). Brady. 2006. pp. 92–97. ISBN 0-13-127824-X. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
