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Advanced Emergency Airway Management in Adults

Advanced Emergency Airway Management in Adults

Advanced Emergency Airway Management in Adults

Advanced Emergency Airway Management involves assessing and planning medical procedures required to restore ventilation or breathing in adults. During trauma or critical cases, the airway can be vulnerable to mechanical obstruction due to a loss of muscle strength and airway reflexes. Since the airway is contaminated with blood, secretions, and other debris, it can further complicate an individual's respiration. Moreover, direct trauma to the face or airway can cause extreme difficulties in breathing. Medical professionals experienced in Advanced Emergency Airway Management in adults follow the principle of ABCs, i.e., airway, breathing, and circulation, to evaluate trauma patients and employ supplemental oxygen and intubation. 

Specialists in the Department of Accident and Emergency Care at Manipal Hospitals, Bhubaneswar, Odisha, are adept at catering to trauma or critical patients, with advanced training in Anaesthesiology, Critical Care Medicine, or Emergency Medicine. With tremendous experience and expertise in the domain, our healthcare team implements appropriate invasive interventions to ensure adequate oxygenation and ventilation to sustain life. 

 

FAQ's

Indications that necessitate the need for Advanced Emergency Airway Management include:

  • Respiratory failure due to low oxygen level (hypoxia) or increased carbon dioxide levels (hypercapnia)
  • Sleep apnoea, characterised by disruption of breathing during sleep
  • Glasgow Coma Scale (GCS) is a tool that helps assess a person’s level of consciousness based on verbal, motor, and eye-opening responses to stimuli. Reduced level of consciousness is an indication, often those with a GCS score of 8 or below, signifying the individual's inability to maintain airway due to impaired reflexes or muscle tone.
  • Rapid change of mental state
  • Injuries or any obstruction in the airway
  • Aspiration, characterised by the entry of foreign substances like food materials into the lungs by accident
  • Trauma in the neck, chest, or abdomen
     

Supraglottic airway devices, abbreviated as SADs, are devices used in opening and maintaining a patient’s airway. The SADs do not require endotracheal intubation and are used when there is a need for quick and secure airway management. SAD’s consist of

  • Oropharyngeal airway (OPA)
  • Nasopharyngeal airway (NPA)
  • Laryngeal Mask Airways (LMA) and Intubating Laryngeal Mask Airways (IILMA)
  • Laryngeal tube (LT)
  • Oesophageal-Tracheal Combitube

OPAs are used in unresponsive patients, while NPAs are employed for patients who are semiconscious or those who have a clenched jaw. LMAs and ILMAs also help in bypassing any obstruction of the airways with the help of inflatable cuffs or balloons. LTs serve as viable substitutes if endotracheal intubation or LMAs are not feasible. Additionally, Endotracheal Intubation is implemented when some SADs are not suitable for addressing airway problems. 
 

In most cases, medical professionals employ the rapid sequence approach in Advanced Emergency Airway Management, which follows a sequence of intubation procedures that consists of four phases: preoxygenation, administration of a drug, positioning of the endotracheal tube, and confirmation of endotracheal tube position. The patient is monitored using a standard electrocardiogram (ECG), end-tidal CO2 monitoring, pulse oximetry, and an automated blood pressure cuff. The medical team specialising in Advanced Emergency Airway Management will examine the airway and pre-oxygenate it with 100% oxygen to increase oxygen levels after the patient stops breathing. The drug is then administered, followed by muscle relaxants. When patients start losing consciousness, one assistant stabilises the neck while the other applies cricoid pressure to prevent regurgitation. The endotracheal tube is positioned, and it is confirmed whether the tube is placed correctly. The patient is closely monitored throughout the procedure to ensure everything goes smoothly. 
 

Specialists employ various methods and interventions to confirm the positioning of the breathing tube, some of which include:

  • Using a laryngoscope for direct visualisation of lungs
  • Imaging scans like bedside mobile ultrasound or chest X-rays
  • End-trial carbon dioxide measurement or capnography
  • Listening for breathing sounds on both sides of the chest and stomach, referred to as auscultation
     

Advanced Airway Management procedures are invasive and may be prone to certain complications, some of which include:

  • Failure to secure the airway
  • Esophageal intubation
  • Hypoxia or hypercapnic respiratory failure that leads to cardiac arrest
  • Injury to the oropharyngeal or laryngeal airway that manifests in soft tissue swelling, bleeding, and injury to vocal cords
  • Tension pneumothorax or air leak from bronchial trauma when intubating chest trauma patients
     

Since the endotracheal tube passes through your vocal cords, you won't be able to speak, eat, or drink. You may feel a significant amount of discomfort or pain, as well as hoarseness or irritation down your throat, when you speak after the intubation is removed. Our specialists will provide personalised instructions to recover your voice and prevent any further damage. 
 

In cases where an intubation procedure cannot be performed, a surgical airway is performed to establish secure means of ventilation. Depending on the severity of the condition and the region of access, surgical procedures employed include:

  • Croicothyroidentomy, by creating an airway through penetration of the cricoid membrane
  • Tracheostomy, a procedure that provides an alternative way of breathing by creating a surgical hole in the trachea
  • Translaryngeal jet ventilation involves the insertion of a catheter into the trachea percutaneously and the administration of oxygen.
     

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