RECOGNITION AND RESPONSE

Recognition

• Assess patency by
  • Looking for chest and/or abdominal movement –
  • Listening for breath sounds and
  • Feeling for expired air.
• Vocalisations, such as crying or talking, indicate ventilation and some degree of airway patency.
• Paradoxical chest and abdominal movements
• Signs of airway obstruction?
  • Foreign body visible?
  • Fully obstructed airway will be silent
• Cyanosis/hypoxia is a late sign

Response

• Call for help if signs of airway obstruction
• Basic airway manoeuvres
  • Older child: Head tilt, chin lift
  • Infant: neutral position
  • Jaw thrust
• Airway adjuncts
  • Oropharyngeal airway
  • Nasopharyngeal airway
• Suction secretions (Yankauer)
• Give oxygen (O2) if required to maintain saturations of 94-98%
• Call an anaesthetist for definitive airway management

Recognition: Look, listen, feel

Immediate assessment to ensure patency of the airway can be done using the look, listen, feel approach.

LOOK

• Chest movements - present or absent, normal or abnormal
• Paradoxical ‘see-saw’ pattern - presence indicates obstruction
• Use of accessory muscles
• Tracheal tug
• Foreign body obstruction
• Misting of the oxygen mask

LISTEN

• Abnormal sounds - snoring, choking, gurgling, hoarseness, stridor
• Complete airway obstruction will be silent

FEEL

• Airflow on inspiration and expiration through the mouth and nose

Figure: Look, listen, feel

Response

• If you are concerned regarding an airway CALL FOR HELP
• Basic airway manoeuvres: Head tilt / chin lift, jaw thrust
• Remove obvious foreign bodies or suction secretions (only under direct vision)
• Use airway adjuncts
• Oxygen – 15 L/min via a reservoir mask

Figure: Non-rebreathe face mask (connected to a supply of oxygen at 15 L/min)

Figure: Suction (This is a demonstration of the use of a Yankauer suction catheter to clear secretions from the mouth. This should be done with observation (direct vision) of where you are suctioning in order to not stimulate the oropharynx in a patient with an intact gag reflex as this can provoke vomiting or laryngospasm.

Investigations to consider in Airway assessment

Primary Investigations

• Continuous oxygen saturation (SaO2) monitoring
• Peak flow rate

Secondary investigations (selected cases)

• Blood gas (capillary, venous or arterial)
• Chest X-ray
• Sputum for culture
• Throat swab