A Modern Approach to Basic Airway Management

A modern approach to the essentials of ventilation & oxygenation Administering oxygen via nasal cannula while treating a patient with CPAP increases the fraction of inspired oxygen and doesn’t typically interfere with the mask seal. Photos courtesy Andrew Merelman You arrive on scene and find a 68-year-old man is lying on the couch with difficulty breathing. He’s obese and obtunded, with severe respiratory distress. His wife tells you he has a history of congestive heart failure. He appears pale and diaphoretic, with snoring, slow, shallow breaths and his initial oxygen saturation is 72%. What are the most important first steps in managing his airway and breathing? Patient Positioning The most crucial factor in airway management is patient positioning. Improper positioning can, and frequently does, inhibit effective ventilation and oxygenation. It’s commonly taught that patients must be supine to enable airway management. This teaching is flawed, as supine is the most dangerous position for a patient with a compromised airway. The most detrimental position for a patient, from an airway perspective, is flat on their back. Supine is best described as the “COFFIN position,” or “Cannot Oxygenate Face Flat In Neutral position.” Why is supine such a compromising position? The primary reason is the tongue. If a healthy person lies on their back, their intrinsic reflexes maintain upper airway tone, which keeps the tongue from occluding the airway. But, when a pa...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Patient Care Source Type: news