Airway management

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration). Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration). Airway management is commonly divided into two categories: basic and advanced. Basic techniques are generally non-invasive and do not require specialized medical equipment or advanced training. These include head and neck maneuvers to optimize ventilation, abdominal thrusts, and back blows. Advanced techniques require specialized medical training and equipment, and are further categorized anatomically into supraglottic devices (such as oropharyngeal and nasopharyngeal airways), infraglottic techniques (such as tracheal intubation), and surgical methods (such as cricothyrotomy, and tracheotomy). Airway management is a primary consideration in the fields of cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine, neonatology, and first aid. The 'A' in the ABC treatment mnemonic is for airway. Basic airway management involves maneuvers that do not require specialized medical equipment (in contrast to advanced airway management). It is mainly used in first aid since it is non-invasive, quick, and relatively simple to perform. The simplest way to determine if the airway is obstructed is by assessing whether the patient is able to speak. Basic airway management can be divided into treatment and prevention of an obstruction in the airway. Treatment includes different maneuvers that aim to remove the foreign body that is obstructing the airway. This type of obstruction most often occurs when someone is eating or drinking. Most modern protocols, including those of the American Heart Association, American Red Cross and the European Resuscitation Council, recommend several stages, designed to apply increasingly more pressure. Most protocols recommend first encouraging the victim to cough, and allowing them an opportunity to spontaneously clear the foreign body if they are coughing forcefully. If the person's airway continues to be blocked, more forceful maneuvers such as hard back slaps and abdominal thrusts (Heimlich maneuver) can be performed. Some guidelines recommend alternating between abdominal thrusts and back slaps while others recommend starting with back slaps first. Having the person lean forward reduces the chances of the foreign body going back down the airway when coming up. Performing abdominal thrusts on someone else involves standing behind them, and providing and inward and upward force in the upper abdomen. Abdominal thrusts can also be performed on oneself with the help of certain objects, such as by leaning over a chair. In adults, there is limited evidence that the head down position can be used for self-treatment of suffocation and appears to be an option only if other maneuvers do not work. In contrast, in children under 1 it is recommended that the child be placed in a head down position as this appears to help increase the effectiveness of back slaps and abdominal thrusts. The American Medical Association and Australian Resuscitation Council advocate sweeping the fingers across the back of the throat to attempt to dislodge airway obstructions, once the choking victim becomes unconscious. However, many modern protocols and literature recommend against the use of the finger sweep. If the person is conscious, they should be able to remove the foreign object themselves, and if they are unconscious, a finger sweep can cause more harm. A finger sweep can push the foreign body further down the airway, making it harder to remove, or cause aspiration by inducing the person to vomit. Additionally, there is the potential for harm to the rescuer if they are unable to clearly see the oral cavity (for example, cutting a finger on jagged teeth).