xperience Summary

This experience demonstrates an operator point-of-view of the key steps in managing a patient's upper airway if breathing stops. The experience is presented from the perspective of the operator, so you can put yourself in their shoes and see what it is like to manage the airway yourself.

The team explain their actions and work their way through airway assessment, basic airway opening manoeuvres, airway adjunct sizing and insertion (oral and nasal airways), bag-valve-mask ventilation, supraglottic airway device (SAD or LMA) insertion and oral intubation of the trachea using a video laryngoscope.

Clinical Context

Effective airway management is a cornerstone of emergency and perioperative care, essential for maintaining adequate oxygenation and ventilation. Airway compromise can arise from a variety of clinical situations, including trauma, altered consciousness, anaphylaxis, or obstructive pathologies. Prompt recognition and a structured, stepwise approach are critical to prevent hypoxia, brain injury, or death.

Initial airway assessment involves the "look, listen, and feel" approach, checking for signs of obstruction, abnormal breathing, and reduced consciousness. The first line of intervention involves basic airway manoeuvres: head tilt–chin lift or jaw thrust (in trauma cases where cervical spine injury is suspected). These manoeuvres help relieve soft tissue obstruction in unconscious patients by repositioning the tongue away from the posterior pharynx.

If basic manoeuvres are insufficient, airway adjuncts such as oropharyngeal (OPA) or nasopharyngeal (NPA) airways may be inserted. OPAs are used in unconscious patients without a gag reflex, while NPAs can be used in semi-conscious individuals with an intact gag reflex.

For patients unable to maintain their airway or if oxygenation/ventilation remain inadequate, progression to advanced airway management is required. This includes the use of supraglottic devices like the laryngeal mask airway (LMA) or definitive airway techniques such as endotracheal intubation. Intubation ensures airway protection and allows for mechanical ventilation, especially in critically ill or anesthetised patients.

In cases where intubation fails or is impossible (e.g., due to anatomical challenges or trauma), emergency surgical airway access—such as cricothyroidotomy—may be needed as a last resort.

Learning Outcomes

1. Assessment of the airway.
2. Basic airway-opening manoeuvres.
3. Oral and nasal airway adjuncts.
4. Supraglottic Airway Device insertion.
5. Oral intubation with a video laryngoscope.

External Resources

• NTSP Algorithms and Bedheads