1. AIRWAY CARE WITH SIMPLE DEVICES

CHAPTER 1. AIRWAY CARE WITH SIMPLE DEVICES




Airway management2


The first procedure used for airway control was probably tracheostomy. Pedro Virgili (1699–1776) from Cadiz used it for the relief of quinsy, but its popularity was assured by its success in the management of diphtheria. The first to use it in the UK for diphtheria was George Martine (1702–1741). The eminent surgeon Sir William MacEwen (1848–1924) first performed intubation of the upper laryngeal orifice and trachea in 1878 as an alternative to tracheostomy, again for the management of life-threatening airway obstruction due to diphtheria.


INTRODUCTION


The assessment of airway patency and its safeguard are essential skills for acute life-support. Recognition of an obstructed airway is initially manifested by a combination of ventilatory efforts and airway sounds reflecting airflow turbulence, which become relatively quickly complicated by the signs of inadequate respiratory function such as cyanosis, tachycardia, and loss of consciousness.


VENTILATORY EFFORT






• Increased accessory muscle activity.


• Mouth opening with each inspiratory effort.


• Suprasternal and chest wall indrawing rather than chest expansion with every inspiratory effort.



AIRWAY MANAGEMENT



AIRWAY CLEARANCE


Look inside the oral cavity and remove any vomitus, debris or foreign bodies with the following devices:





• Magill’s forceps (Fig. 1.1 B) – in the acute setting these are used to remove foreign bodies from the oral cavity. Magill’s forceps are also used to guide nasogastric tubes into the oesophagus under direct vision and to place pharyngeal packs.


BASIC AIRWAY TECHNIQUES






• Head tilt, chin lift (Fig. 1.2): avoid if suspected cervical spine trauma – place one hand on the patient’s forehead and the fingertips of your other hand under the patient’s chin. Whilst gently tilting the head back lift the patient’s chin to open the airway.



• Jaw thrust (Fig. 1.3) – this is the technique of choice in the presence of suspected cervical spine injury. Place the index fingers behind the angle of the mandible and apply steady upwards pressure to bring the mandible forwards. Slightly open the mouth by downwards displacement of the chin with your thumbs.




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Suspected C-spine injury – The jaw thrust is the technique of choice in such patients for basic airway management, with manual in-line stabilization of the head and neck performed by a second operator. However, the primary and over-riding objective in all cases is the maintenance of a patent airway as an obstructed airway is the most immediate threat to life.

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Apr 3, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on 1. AIRWAY CARE WITH SIMPLE DEVICES

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