Airway

Management

First consideration for airway management should be postural - Recovery Position.

Only if the recovery position is not appropriate, or other interventions are required should you consider alternative airway management.

Recovery Position

Head-tilt, chin-lift manoeuvre

Position the patient on their back.

Open their airway using a head-tilt chin-lift manoeuvre:

Place one hand on the patient’s forehead and the other under the chin.
Tilt the forehead back whilst lifting the chin forwards to extend the neck.

Jaw thrust

If the patient is suspected to have suffered significant trauma (with potential spinal involvement) and requires airway management, perform a jaw-thrust rather than a head-tilt chin-lift manoeuvre:

Kneel at the patient's head
Place heels of hands on the patient's cheek bones
Place 2-3 fingers under the corner of the mandible (jaw) as shown
Pull the jawbone up towards you, whilst maintaining pressure on the cheekbones
If possible, use your thumbs to push the chin and open the mouth slightly
DO NOT RELEASE - unless exhausted, patient condition improves or instructed to do so by a medical professional.

Oropharyngeal Airways (OPA)/ Guedel Airway

Key facts:

An oropharyngeal airway can help prevent the tongue and soft tissues of the pharynx from obstructing the airway.
There are a variety of sizes available for children and adults.
Size a patient’s airway by measuring the Guedel against a patient’s face: when the tip is placed at the angle of the jaw the flange should align with the centre of the top teeth (i.e. hard airway = measure “hard to hard”).
Insert into the patient’s mouth upside down, pass to the back of the throat and rotate 180 degrees to fit behind the tongue base.

*In children, the Guedel should be inserted the right way up (i.e. not upside down).

Issues with Guedel airways:

They are poorly tolerated in conscious and semi-conscious patients as it induces a gag reflex.
They can cause trauma to teeth and the mucous membranes of the oral cavity.

Contra-incidations of OPA use: (Do not use if:)

If your patient has a gag reflex
Serious Maxillo-facial trauma

Source: Geeky Medics

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