Air passage way; structure and managment

Airway Anatomy

The airway can be divided into two parts: the upper and lower airway. The upper airway is composed of the oropharynx and nasopharynx. The nasopharynx consists of two passages through the nose and into the posterior oropharynx. Air passing through the nose is warmed and particles are filtered by the nasal hairs. The largest diameter of the nasal passages is in the inferior compartment, which is important to remember when placing a nasopharyngeal airway. The oropharynx starts at the mouth and ends at the trachea. The mouth includes the tongue inferiorly and the hard palate superiorly. The tongue has many functions, but for our purposes it is only a problem. The tongue is the most common reason for airway obstruction because in the supine unconscious athlete it can slide backward and occlude the passage of air into the trachea. This situation is commonly described as the tongue being “swallowed,” although swallowing the tongue is not actually possible. The lower airway consists of the epiglottis and the larynx. The epiglottis is a flap that covers the opening to the trachea (the glottis) when food or fluid passes into the esophagus. The larynx is composed of nine cartilages and muscles and is located anterior to the fourth, fifth, and sixth cervical vertebrae in adults. The larynx is also known as the Adam’s apple. It is a dynamic structure and protects the glottis while also allowing phonation.

Air passage way; structure and managment

Airway Compromise

Airway patency is a term used to describe the status of the airway. An open and clear airway is called patent, whereas an obstructed airway is compromised. Signs of an obstructed airway include snoring respirations, sternal and intercostal retractions, accessory muscle use, and gurgling. Snoring respirations are common and indicate that the tongue is partially occluding the airway. A smooth and symmetrical expansion of the thorax indicates a normal respiratory effort. The condition in which the upper sternum sinks inward while the remainder of the sternum expands outward is called sternal retractions and very little air is exchanged with each breath.

Airway Adjuncts

The oropharyngeal (OP) and nasopharyngeal (NP) airways are used to relieve an obstructed airway after the initial jaw thrust maneuver has shown its effectiveness. The athletic trainer will find the jaw thrust maneuver physically demanding if done over an extended period, and switching to either of these airways as soon as possible is warranted. The adult OP airway comes in small, medium, and large sizes  and is made of hard plastic. Metric sizes

are sometimes found in 8, 9, and 10 mm. Proper sizing is made by holding the airway along the cheek. It should

stretch from the tip of the ear to the corner of the mouth. Inserting the OP airway requires stabilizing the tongue with a tongue depressor and sliding the airway into the posterior oropharynx following the natural curve of the airway.

Oxygen Therapy

Airway management is not complete without the administration of supplemental oxygen. Athletic trainers need to check the scope of practice defined by their state licensure acts, but short-term oxygen administration is not contraindicated in an emergency situation. Involvement of the team physician in the decision to provide oxygen therapy may resolve any conflicts.

A simple face mask (see Fig. 3-9B) will deliver a FiO2 of 40% to 60% at 6 to 10 L/m, whereas a reservoir bag face

mask will deliver 60% to 90% at 10 to 15 L/m. The reservoir bag face mask (also referred to as a partial nonbreather mask) is preferred for patients who are unconscious or unstable. Although it is common for emergency medical

technicians (EMT) to use 15 L/m with either type of face mask, the clinical difference in FiO2 between 10 and 15 L/m is insignificant and will only drain the tank one third faster. This is an important consideration if using a D tank.

The bag valve mask (BVM) (see Fig. 3-9D) is used to either assist the breathing or ventilate a patient with apnea.

An adult BVM has a capacity of approximately 1600 cc and uses a mask to maintain a seal around the face. When connected to an oxygen source and using a reservoir bag, the BVM will deliver a FiO2 of nearly 100%. The flow rate

should be sufficient to fill the bag with each ventilation or 10 to 15 L/m. The BVM may also be connected to an endotracheal tube if the patient is intubated. All artificial breathing tubes (endotracheal, laryngeal mask airway [LMA], combitube, and King laryngeal tube-disposable [King LT-D]) have the same 15 mm connector for the BVM

Laryngeal Mask Airway

The LMA was developed in Great Britain in the late 1980s and is often used in operating rooms for minor surgical cases requiring general anesthesia. The LMA comes in eight sizes based on weight, including pediatric. It is blindly

inserted into the posterior oropharynx, and the cuff is inflated with 10 to 30 cc of air, creating a seal around the glottis opening. A BVM is attached and the patient is ventilated. The LMA does not prevent aspiration of gastric contents and the seal may be lost when moving the patient.

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