Basic airway management is a life-saving procedure for patients who have inadequate ventilation or inadequate oxygenation. Bag-mask ventilation is the most important component of basic airway management. Simple maneuvers and basic airway adjuncts can ensure a patent airway and allow for effective oxygenation and ventilation. This chapter will review the essential techniques and airway adjuncts used in basic airway management in adults. Issues related to endotracheal intubation and other advanced airway management techniques are discussed elsewhere. INDICATIONS Inadequate respiratory effort Basic airway management is often required if a patient has an inadequate respiratory effort. Causes can be intrinsic (e.g., intracranial hemorrhage) or extrinsic (e.g., opioid overdose). Inadequate respiratory effort may be difficult to ascertain. Detection depends on close observation of chest wall movement and requires that the patient be undressed so the respiratory rate, pattern and depth of breathing, use of accessory muscles, and signs of injury can be seen. Airway obstruction Prolapse of the tongue into the posterior pharynx because of loss of submandibular muscle tone is the most common cause of airway occlusion in an unconscious patient. Other causes of airway obstruction include presence of foreign bodies, blood, and secretions. Clinical Pearls: Noises produced by the obstructed upper airway often make such obstruction easier to detect than poor respiratory effort. As an example, snoring or gurgling noises may be heard when the upper airway becomes partially obstructed by soft tissue or liquid. Complete airway obstruction is silent but may manifest transiently as retractions of the accessory muscles of respiration or cyanosis. Head-tilt chin-lift maneuver Use one hand to apply downward pressure on the patient's forehead. Used the tips of the index and middle finger of the other hand to lift the mandible. Jaw-thrust maneuver Placed the heels of both hands on the side of the patient's goal. Grasp the angles of the mandible with your index and long fingers to push the jaw anteriorly. Oropharyngeal airway insertion Select the correct size OPA by measuring the distance from the patient's mouth to the angle of the mandible. Select an OPA that corresponds to this distance. Insert the OPA while it is inverted. Rotate the OPA 180 degrees when it reaches the posterior pharynx. Nasopharyngeal airway insertion Select the correct side NPA by measuring the distance from the tip of the patient's nose patient's to the angle of the mandible. Select an NPA that corresponds to this distance. Lubricate the NPA. Insert the NPA along the floor of the nasal cavity. Bag-valve mask ventilation Open the airway with the maneuvers described above. Place the mask on the patient's face. First apply the mask to the bridge of the nose, then lower it onto the face. Use either the one- or two-handed technique to secure the mask to the face. Refer to the Full Details section for additional information about this complex task. Ventilate the patient at a rate of 10-12 breaths per minute, at a tidal volume of 8-10 mL/kg.

• published: 27 Sep 2013
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