Basics of Airway Management (Paramedic)

00:01 I welcome you to the lecture on airway management and suction.

00:05 We will start with a short introduction on the theory and then go over the practical implementation. What is accomplished by clearing the airway ? The most obvious would be helping the patient to adequately breathe again.

00:21 There are two general approaches to clear the airway.

00:24 The first consists primarily of simple measures, including lateral positioning, opening the mouth, a nd clearing debris with the fingers or with Magill forceps.

00:46 With these two simple measures, you must only clear out easily visible foreign bodies and refrain from reaching beyond the clearly visible area. If the simple measures do not result in improvement, we may need to take more advanced measures in order to see deeper into the airway, a laryngoscopy can be performed.

01:10 This allows visualization of the epiglottis and glottis, a nd if necessary, helps facilitate the removal of foreign bodies with the Magill forceps If the patient is able to tolerate the procedure.

01:23 Care must be taken to not provoke swelling or bleeding during this process.

01:32 Laryngoscope can also be used to suction the lower airways, a technique known as "endobronchial suctioning." Again, be very careful here as well.

01:44 The invasive measures involve increased difficulty and carry the risk of more significant complications.

01:50 Therefore, the provider must understand the procedure and practice it frequently to master the technique.

01:55 The first step, understanding the theory, is what we can do now.

01:59 There are many variations of pumps that can be used for suction.

02:05 Most emergency personnel carry at least electric section and many even carry mechanically operated pumps.

02:13 With a fingertip placement over the accessory hole on the stylet, you can control the negative pressure generated by the device.

02:21 This may be helpful if you want to advance the catheter without suction, and then start the suction in a controlled manner only once it has reached the target location.

02:29 Upper airway suction has many advantages.

02:32 It is generally easy to perform and is less invasive to the patient.

02:36 It does not necessarily have to be performed under sterile conditions, and it is associated with a comparatively high patient tolerance.

02:45 The nasal, oral, and pharyngeal cavities can all be suctioned.

02:49 If, however, the aspiration procedure needs to be done deeper in the trachea or bronchial tree, a more invasive procedure is needed.

02:56 The provider must work in a sterile field as possible, and may choose to use a laryngoscope to improve their visualization.

03:04 If the patient is already intubated, the catheter can be passed through the endotracheal or laryngeal tube.

03:11 Before I show you exactly how the suction w orks, I would like to talk about the catheter options.

03:17 Catheters come in different sizes, usually in the Charrière scale.

03:22 You can see the sizes and colors here in the table.

03:29 In addition, certain catheters are designed differently to be used for different functions. Some have rounded, atraumatic tips that minimize injuries during advancement.

03:44 The rigid Yankauer catheters are used primarily in pediatrics, and are particularly suitable for aspirating highly viscous mucus or vomit from the upper respiratory tract.

04:00 Another tool is the suction booster canister, which serves as a collection reservoir for larger quantities of aspirated material.

04:08 In the technique video, I would now like to show you how endobronchial aspiration works and what you must pay attention to when sterile handling the aspiration catheter.

04:22 The emergency Service finds an unconscious person in a sitting position.

04:25 She is transferred directly to the floor and positioned in the supine position.

04:34 After checking her consciousness, the oral cavity is checked.

04:39 A foreign body is found and removed with the aid of the Magill forceps.

04:49 Since fluid has also accumulated in the oral cavity, a catheter is used to aspirate the material.

05:01 The mouth is opened for this purpose with the aid of the cross grip.

05:09 After clearing the airway, the head is hyperextended.

05:13 Breathing is then assessed for a maximum of ten-seconds.

05:18 Further therapeutic options depend on the findings obtained.

05:24 So let us summarize the most important concepts once again.

05:28 We must have a clear airway to facilitate sufficient breathing and ventilation. We distinguished between simple and advanced measures for clearing the airway. Laryngoscopy is a simple but invasive procedure and carries risks such as vomiting or vagus stimulation.

05:47 Suction catheters for aspirating liquids from the oral cavity are available in various colors, sizes and designs specific to their function.