Basic and Advanced Airway Management

Airway Anatomy

100

Central conduit for air,  injury or obstruction to it can be life-threatening.

Trachea 

200

This structure prevents food or liquids from entering the airway during the swallowing process.

Epiglottis 

300

This landmark divides the trachea into the left and right main bronchi.

Carina

400

One of the three cartilages of the larynx, alongside the thyroid and cricoid

Arytenoid cartilage

500

This is the airway opening seen during laryngoscopy

The Glottis 

Basic Airway Technique

100

Maneuver that lifts the chin and tilts the head back to open the airway in patients without suspected spinal injury.

Head-tilt, chin-lift

Ind: Unconscious patient without evidence of cervical injury
Contra: Suspected spine trauma or injury

200

During trauma intubation, this maneuver is used to open the airway while protecting the cervical spine.

Jaw Thrust

300

Mention an adjunct used to protect the airway in unconscious patients who lack a gag reflex vs one used in semi-conscious patients or those with an intact gag reflex, with no history of trauma 

Oral pharyngeal airway ( OPA) 

Ind: Unconscious, no gag reflex
Contra: Conscious patient

measurement

vs 

Nasal pharyngeal airway (NPA)

Ind: Semi-conscious patient
Contra: Basilar skull fracture, nasal trauma

Measurement

400

You’re suctioning a patient who has vomited during resuscitation. What’s the maximum time you should apply suction to prevent hypoxia?

No more than 10–15 seconds

500

Airway clearance is mainly used to remove secretions, foreign bodies, or liquids that obstruct the airway to ensure airway patency and effective ventilation. Mention commonly used tools 

• Suction Machine: Uses negative pressure to remove mucus, blood, and vomit from the mouth, pharynx, or airway.
• Suction Catheter: Used with the suction machine, inserted deep into the airway for targeted suctioning.
• Yankauer Suction Tip: Commonly used to clear secretions from the mouth and pharynx; its rigid design is suitable for removing larger amounts of secretions.
• Endotracheal Suction Catheter: Used to suction secretions inside the trachea to prevent blockage and infection.

Advanced Airway Devices

100

Gold standard for a definitive airway, especially in patients at risk of aspiration.

An Endotracheal Intubation

• It requires skill and frequent practice.
• It carries the risk of esophageal intubation.
• It may delay other critical interventions if not performed efficiently.

200

A device placed above the glottis to secure the airway without vocal cord visualization.

supraglottic airway (LMA, i-gel, King LT)

These are devices inserted blindly and provide a secure airway without visualization of the vocal cords.

 They’re fast, effective, and ideal for experienced and less confident providers during high-stress situations

Advantages: Quick placement, Less training required than intubation, and excellent for cardiac arrest

300

What tool is used to visualize the vocal cords during intubation?

Larngoscope 

400

Methods to clinically confirm endotracheal tube placement immediately after intubation

Chest rises during baging 

Mist on the tube 

Five-point auscultation 

500

The most reliable method for confirming ET tube placement and monitoring ventilation continuously, which is more available in hospital settings 

Waveform capnography 

• Confirming tube placement
• Monitoring ventilation quality during CPR
• Detecting ROSC (Return of Spontaneous Circulation)
• Assessing for airway obstruction or bronchospasm

Normal end-tidal CO₂ readings range from 35–45 mmHg, and a continuous waveform provides a clear picture of ventilation status in real-time.

Techniques of Intubations

100

The "Why"? 

What are the indications of Endotracheal intubation?

Airway Protection: Patients unable to protect their own airway due to conditions like apnea or a low GCS score (typically ≤8) require intubation. 

Oxygenation and Ventilation: Intubation is indicated when a patient experiences hypoxia (poor oxygenation) or hypercarbia (poor ventilation, often with respiratory acidosis) that cannot be corrected with basic airway management. 

Failure to Maintain Airway Patency: This includes patients with airway obstructions that basic methods cannot manage, or those with a high risk of airway collapse. 

Anticipated Clinical Deterioration: Intubation may be performed to secure the airway when a patient's condition is expected to worsen rapidly and lead to respiratory failure. 

200

The "How"? 

What are the Methods used to perform the intubation?

Direct Laryngoscopy: directly visualize the vocal cords using the laryngoscope 

Video Laryngoscopy: a video screen to provide a view of the airway, which improves visualization. Nasotracheal Intubation: Placing the tube through the nose instead of the mouth. 

Awake Intubation: Performing intubation with the patient awake, often using a fiber optic bronchoscope to guide the tube. 

300

How would you predict difficulty intubation? 

L: look Externally: Signs of trauma, large tongue, or obesity.

E: evaluate 3-3-2 Rule: A measure of the length of the airway opening.

M: mallampati Score: Visual assessment of the tongue and throat.

O: obstruction: Blockage or swelling in the upper airway.

N: neck Mobility: Limited movement, such as with cervical spine immobilization.

400

Field intubation is the placement of an advanced airway or endotracheal tube (ET) by emergency medical services (EMS) personnel outside the hospital setting.what are the strategies during intubation process 

Preparation

Preoxygenation

Pretreatment

Paralysis with induction

Positioning

Placement with proof

Post intubation management

500

After successful intubation, the patient’s SpO₂ drops suddenly, and breath sounds are heard only on the right side. What complication has likely occurred?

Right mainstem bronchus intubation

Miscelleneous

100

Mention the immediate complication of endotracheal intubation during or right after intubation 

(BATHES )

Bradycardia/ Hypotension

Aspiration

Trauma ( Airway trauma, bleeding, dental trauma )

Hypoxia

Esophageal Intubation 

Selectively intubated ( usually the right Mainstem  )

200

Mention early complication of endotracheal intubation

Hypotension/shock

Pneumothorax /Barotrauma

Incorrect tube depth  or displacement 

Vocal cord injury / laryngeal edema

 

300

Mention the Late complications of endotracheal intubation

Tracheo stenosis

Ventilator-Associated Pneumonia ( VAP)

Necrosis/ulceration of the tracheo-mucosa 

Laryngeal granuloma/ scarring 

500

It’s 07:15 AM. You and your partner respond to a two-vehicle collision on a rural highway. A 32-year-old male driver was found unconscious in the front seat after striking a tree. The dashboard and steering wheel show significant damage. There’s heavy bleeding from the scalp, and the patient is breathing irregularly.

On initial Assessment:

• General Impression: Unconscious, shallow respirations, gurgling sounds.

• Airway: Partially obstructed with blood and secretions.

• Breathing: Rate 8/min, irregular, shallow chest rise.

• Circulation: Carotid pulse weak, radial pulse absent.

• Skin: Cool, pale, diaphoretic.

• SpO₂: 78% on room air.

• GCS: 5 (E1, V1, M3).Qn Outline the management of this patient

Step

Action

Key Points / Notes

1. Scene Safety & PPE

Scene secured by police. PPE applied.

Gloves, eye protection, and face shield worn before patient contact.

2. Basic Airway Management Attempt

Manual jaw-thrust applied.

Used due to suspected cervical spine injury.

Yankauer suction used to clear blood.

Clears visible blood and secretions for better visualization.

BVM ventilation attempted with O₂ reservoir.

Minimal chest rise observed — inadequate ventilation.

3. Indications for Advanced Airway

Unconscious (GCS <8).

Unable to protect airway.

Inadequate ventilation with BVM.

Poor chest rise despite optimization.

Ongoing airway obstruction (blood, trauma).

Persistent airway compromise.

4. Preparation for Intubation (RSI if protocol allows)

Preoxygenate with 100% O₂ for 2 minutes.

Use BVM with reservoir for denitrogenation.

Check all equipment.

Laryngoscope light, ET tubes (7.5–8.0 mm), suction, bougie, syringe, capnography, securing device.

Assign team roles.

Ventilation, suction, medication, monitoring clearly designated.

5. Procedure

Maintain cervical spine in-line.

Avoid neck movement in trauma.

Perform suction during laryngoscopy.

Keeps airway clear of blood.

Visualize vocal cords and pass ET tube.

Advance to 22 cm mark at the teeth.

Connect tube to BVM and ventilate.

Observe for chest rise and improved oxygenation.

6. Confirmation of Tube Placement

Observe bilateral chest rise.

Confirms air entry into both lungs.

Check absence of epigastric sounds.

Rules out esophageal intubation.

Verify capnography waveform.

Gold standard for confirmation.

Monitor SpO₂ improvement.

Target saturation >94%.

7. Post-Intubation Care

Secure tube with holder.

Prevent dislodgment during transport.

Adjust ventilation rate.

10 breaths/min for adult trauma patient.

Continue waveform capnography monitoring.

Early detection of dislodgment or obstruction.

Initiate transport to trauma center.

Maintain ongoing monitoring en route.