I. Manual Techniques – used for suctioning and the prevention of tongue obstruction
a) Head Tilt-Chin Lift
- preferred
- use in cases of altered mental status and suspected airway obstruction
- should not be used if c-spine injury is suspected
b) Jaw-Thrust Maneuver
- use in cases of altered mental status and suspected airway obstruction
- should not be used if patient is conscious
II. Mechanical Adjuncts – use when the airway cannot be manually opened
a) Oropharyngeal Airway (OPA)
- for the prevention of tongue obstruction; remove immediately if the patient gags
- used for unresponsive patients without a gag reflex
- should not be used on conscious patients or any patient with an intact gag reflex
- measure from the corner of the mouth to the earlobe
- insert it upside down with distal end facing the roof of the mouth, then rotate it 180 degrees
b) Nasopharyngeal Airway (NPA)
- for the prevention of tongue obstruction; remove immediately if patient gags
- used for patients with a decreased level of consciousness, but with an intact gag preventing the use of an OPA
- should not be used if the patient has a severe head injury or facial trauma, experiences resistance in both nostrils, or is conscious.
- measure from the tip of the nose to the earlobe
- lubricate before insertion; always insert with bevel facing septum; try larger nostril first
III. Supplemental Oxygen
– used for patients in cardiac arrest, receiving artificial ventilations, hypoxia, hypoperfusion, ALS
– do not use near a fire
a) Nonrebreather Masks (NRB)
- preferred
- 10-15 lpm
- “high-flow” oxygen
b) Nasal Cannula
- use if patient cannot tolerate NRB or needs long-term oxygen therapy
- 1-6 lpm
- “low-flow” oxygen
IV. Assisted Ventilation
– indicated for patients with inadequate spontaneous breathing leading to severe respiratory distress or respiratory failure
– any unresponsive patient receiving assisted ventilations should have an airway adjunct (OPA/NPA)
– when in doubt, begin assisted ventilations
– patients requiring assisted ventilations are usually unresponsive, but not always
– tidal volume: it should take at least 1 second to inflate the chest
a) Bag Valve Mask (BVM) Device
- most frquently used
- can be used with a mask or an advanced airway device
- Two-rescuer BVM technique preferred
b) Continuous Positive Airway Pressure (CPAP)
- used for patients with sleep apnea, COPD, or pulmonary edema; also used for conscious patients with moderate to severe respiratory distress
- can help patient avoid intubation
