They should be used in conjunction with the maneuvres mentioned above as the position of the head and neck need to be maintained to keep the airway aligned.Īn oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. Oropharyngeal airway (Guedel)Īirway adjuncts are often helpful and in some cases essential to maintain a patient’s airway. Using your thumbs, slightly open the mouth by downward displacement of the chin. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible.ģ. If the patient is suspected to have suffered significant trauma with potential spinal involvement, perform a jaw-thrust rather than a head-tilt chin-lift manoeuvre:Ģ. If an obstruction is visible within the airway, use a finger sweep or suction to remove it. Inspect the airway for obvious obstruction. Tilt the forehead back whilst lifting the chin forwards to extend the neck.ģ. Place one hand on the patient’s forehead and the other under the chin.Ģ. Open the patient’s airway using a head-tilt chin-lift manoeuvre:ġ. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Regardless of the underlying cause of airway obstruction, seek immediate expert support from an anaesthetist and the emergency medical team (often referred to as the ‘crash team’). Depressed level of consciousness: causes include opioid overdose, head injury and stroke.Laryngospasm: causes include asthma, gastro-oesophageal reflux disease (GORD) and intubation.Local mass effect: causes include tumours and lymphadenopathy (e.g.Soft tissue swelling: causes include anaphylaxis and infection (e.g.Vomit/secretions in the airway: causes include alcohol intoxication, head trauma and dysphagia.Blood in the airway: causes include epistaxis, haematemesis and trauma.Inhaled foreign body: symptoms may include sudden onset shortness of breath and stridor.There is a wide range of possible causes of airway compromise including: Open the mouth and inspect: look for anything obstructing the airway such as secretions or a foreign object.Look for signs of airway compromise: these include cyanosis, see-saw breathing, use of accessory muscles, diminished breath sounds and added sounds.Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Airway Clinical assessment Can the patient talk? If the patient is unconscious or unresponsive, start the basic life support (BLS) algorithm as per resuscitation guidelines. Make sure the patient’s notes, observation chart and prescription chart are easily accessible.Īsk for another clinical member of staff to assist you if possible. Introduce yourself to the patient including your name and role.Īsk how the patient is feeling as this may provide some useful information about their current symptoms.Īn inability to speak in full sentences indicates significant shortness of breath. Introduce yourself to whoever has requested a review of the patient and listen carefully to their handover. You may be asked to review a patient with pulmonary oedema due to shortness of breath. Initial stepsĪcute scenarios typically begin with a brief handover from a member of the nursing staff including the patient’s name, age, background and the reason the review has been requested. You might also be interested in our medical flashcard collection which contains over 1000 flashcards that cover key medical topics. Your assessment and management should be documented clearly in the notes, however, this should not delay initial clinical assessment, investigations and interventions.Any medications or fluids will need to be prescribed at the time (in some cases you may be able to delegate this to another member of staff).Make use of your local guidelines and algorithms in managing specific scenarios.Review results as they become available (e.g.If you require senior input, call for help early using an appropriate SBARR handoverstructure.Clearly communicate how often would you like the patient’s observations relayed to you by other staff members.
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