Techniques for Establishing and Maintaining a Patient's Airway

Authors

Hiba Abdulkarim Deria, Mona Abdullah bin Thwiny, Tarfa Mubarak Aldossari

Abstract

Whatever the technique employed, the wise provider will continually assess his progress in establishing and maintaining the airway. Signs of success include an increase in the rate or volume of chest rise, the production of a respiratory sound where there was none before, fogging in the tube of a tracheal intubation attempt, or colorimetric change in a CO2 detector. Should these signs occur, it is important to secure the means of maintenance, as the drowning victim might be pulled from the water only to fall back in. Patients who show any decline in respiratory status, or those who have a high risk of doing so, should be promptly considered candidates for advanced airway management techniques. Remember that airway management can be a matter of life and death and bears a greater potential to help patients than to harm them, as long as the provider is conscious of the risks and benefits of each intervention. (van et al.2021)
For patients who have not suffered injury but who are unconscious or generally prone to loss of muscle tone, the recovery position of lying on one's side may prevent airway obstruction by allowing the tongue to fall forward from the posterior pharynx. This is generally suitable for all patients other than those at risk of aspiration of stomach contents or those with conditions compromising air exchange. Patients with facial trauma or some form of airway obstruction will likely need immediate and/or advanced airway maneuvers to ensure adequacy of ventilation. (Skellett et al.2021)
How profoundly a patient's airway should be managed depends largely upon the patient's level of consciousness and likelihood of maintaining a functional airway without intervention. For the unconscious patient, or for the conscious patient who has a high likelihood of losing consciousness, the job may be as simple as positioning the patient's head and opening the mouth. The patient's own muscle tone may be adequate, and the airway can be maintained with relatively little effort. Providing manual maneuvers have not been prohibited with a cervical collar, this class of patient will generally benefit from both the head tilt/chin lift and the jaw-thrust maneuver. In using these maneuvers, rescuer posture should always be positioned as perpendicular as possible to the patient's head to minimize the rescuer's exertion and to maximize control. (Singh et al.2020)
The goal of every emergency medical technician, paramedic, nurse, nurse anesthetist, trauma doctor, or primary care physician is to rapidly and correctly establish an airway so that delivery of oxygen to the lungs, and removal of carbon dioxide from the lungs, is assured. This is so fundamental to patient survival that it merits a significant investment of time and effort for every healthcare provider to become proficient in airway management. It may come as a surprise to some readers how many patients are mishandled in this seemingly simple aspect of their care, the victims of two or more rescuers who were ill-prepared or poorly coordinated in their approach to the patient's airway. (Cook et al.2020)

Keywords

airway management, endotracheal intubation, patient safety, critical care, emergency medicine

Techniques for Establishing and Maintaining a Patient's Airway. Hiba Abdulkarim Deria, Mona Abdullah bin Thwiny, Tarfa Mubarak Aldossari. 2021. IJIRCT, Volume 7, Issue 1. Pages 1-5. https://www.ijirct.org/viewPaper.php?paperId=2404074