Airway on emsenn.net

Fri, 06 Mar 2026 00:00:00 +0000

¶What you will be able to do

Distinguish between oxygenation (oxygen into blood, measured by SpO2) and ventilation (gas movement and CO2 clearance, measured by capnography), and explain why treating a ventilation problem with supplemental oxygen alone is insufficient.
Localize airway obstruction as upper (stridor, inspiratory difficulty) or lower (wheeze, expiratory difficulty) based on clinical signs, and explain why localization determines the intervention.
Apply the staged escalation framework: positioning → supplemental oxygen → airway adjuncts → positive-pressure ventilation → advanced airway, selecting the least invasive intervention that maintains oxygenation and ventilation.
Identify high-risk clinical signs that indicate impending airway failure: inability to speak in full sentences, stridor at rest, silent chest despite respiratory effort, worsening mental status, accessory muscle use, and tracheal tug.
Describe the anatomical differences in pediatric airways (larger occiput, anterior larynx, subglottic narrowing, lower oxygen reserve) and explain how they change management.
Articulate the immediate post-intubation priorities: confirm placement with capnography, secure the tube, anticipate post-intubation hypotension, ensure adequate sedation and analgesia.

¶Prerequisites

No formal prerequisites. The introductory curriculum is self-contained.
Familiarity with the respiratory system and nervous system is helpful.

¶Reference documents

Introduction to Airway Management — the introductory lesson
Airway Anatomy and Physiology Basics — structural foundation
Airway Assessment and Clinical Reasoning — bedside evaluation
Oxygen Delivery and Ventilation Support — the support ladder
Airway Treatment Principles — staged escalation
Pediatric Airway Differences — what changes in children
Post-Intubation Safety and Reassessment — after the tube
Common Airway Illnesses and Syndromes — clinical patterns

¶Scope

This skill covers conceptual understanding of airway assessment and the logic of airway management. It does not cover:

Introduction to Airway Management

Fri, 06 Mar 2026 00:00:00 +0000

¶Why the airway comes first

In emergency medicine, the ABCs — Airway, Breathing, Circulation — are not a mnemonic convenience. They are a priority sequence based on a physiological fact: a patient can survive minutes without circulation, but only seconds to minutes without a patent airway. Everything else — IV access, medications, imaging, definitive treatment — is irrelevant if the patient cannot move air.

This is not because the airway is more complex than other organ systems. It is because the airway is the bottleneck. The cardiovascular system can only deliver oxygen the respiratory system has acquired. The respiratory system can only acquire oxygen the airway allows to pass. A blocked airway makes every downstream system fail simultaneously.

Applying Free Open-Access Medicine (FOAM) to Airway Topics Safely

Tue, 03 Mar 2026 14:00:00 -0600

Use this page as a bridge between rapid FOAM learning and core airway medicine.

¶Map FOAM claims to foundation type

When reviewing airway FOAM content, classify each claim before deciding what to do with it:

Anatomy/physiology claim: verify against stable references.
Assessment claim: check consistency with guideline frameworks.
Procedure claim: treat as high-risk until locally validated.
Medication/strategy claim: verify indication, contraindication, and monitoring requirements.

¶Minimum validation workflow

Identify the exact claim being made.
Link at least one primary source or guideline.
Check fit with your local protocol and resources.
Decide status: learning-only, discuss, or operationalize.

¶Common airway FOAM failure modes

Technique-first teaching without physiology framing.
Overgeneralized recommendations from single high-drama cases.
Missing explicit stop points, rescue pathways, or contraindications.
Confident claims with weak source linkage.

¶Use with the airway module

This pairing keeps FOAM fast while keeping clinical reasoning explicit and auditable.

Oxygen Delivery and Ventilation Support

Tue, 03 Mar 2026 14:00:00 -0600

¶Core distinction

Oxygenation and ventilation are related but not interchangeable.

Oxygenation: getting oxygen into blood.
Ventilation: removing carbon dioxide and moving gas effectively.

A patient can have acceptable oxygen saturation while ventilation worsens.

¶Support ladder (conceptual)

Low-burden oxygen support for mild hypoxemia.
Higher concentration oxygen interfaces when demand rises.
Positive-pressure support (noninvasive or invasive) when work of breathing or gas exchange failure escalates.

The operational goal is to match support level to physiology and trajectory, not to a fixed device preference.

Pediatric Airway Differences

Tue, 03 Mar 2026 14:00:00 -0600

¶Why pediatric airway gets separate attention

Children are not just smaller adults in airway management. Anatomy, physiology, and reserve differ in ways that change risk recognition and technique planning.

¶Core anatomic and physiologic differences

Larger occiput in infants can flex the neck when supine, affecting alignment and patency.
Proportionally larger tongue and smaller mandible can increase upper-airway obstruction risk.
Larynx is positioned more cephalad and anterior in younger children.
Glottic/subglottic region is relatively narrow; small edema can produce clinically meaningful obstruction.
Oxygen reserve is lower and oxygen consumption is higher, so desaturation can occur faster.

¶Clinical implications

Positioning is not optional; optimize head/neck alignment before escalation.
Prepare backup oxygenation strategies early because deterioration can be rapid.
Limit repeated traumatic attempts; use planned escalation and early help requests.
Reassess work of breathing and mental status frequently because trajectory can change quickly.

¶Diagnostic framing

When pediatric respiratory distress is present, separate these questions:

Post-Intubation Safety and Reassessment

Tue, 03 Mar 2026 14:00:00 -0600

¶Immediate priorities after tube placement

Confirm tracheal placement using waveform capnography and full clinical context.
Stabilize oxygenation and ventilation targets.
Secure the tube and document depth/position.
Begin ongoing sedation/analgesia strategy per local protocol.
Reassess hemodynamics and treat post-intubation instability promptly.

¶Early complications to watch for

Esophageal intubation or tube displacement.
Mainstem bronchial intubation.
Post-intubation hypotension.
Tension physiology or worsening dynamic hyperinflation in susceptible patients.
Aspiration-related deterioration.

¶Reassessment cadence

Post-intubation care is not a one-time check. Reassess oxygenation, ventilation, perfusion, and tube position repeatedly during early stabilization and after any transfer or major movement.

Airway Anatomy and Physiology Basics

Tue, 03 Mar 2026 13:00:00 -0600

¶Core anatomical map

The airway is commonly divided into upper and lower segments.

Upper airway: nose, oral cavity, pharynx, and larynx.
Lower airway: trachea, bronchi, bronchioles, and alveolar pathways.

Clinically, this split matters because upper-airway processes (for example swelling, soft-tissue collapse, or supraglottic obstruction) often present and respond differently than lower-airway processes (for example bronchospasm).

¶Four bedside functions

Patency: can air move through the airway without critical obstruction?
Oxygenation: can oxygen reach blood across the lungs?
Ventilation: can carbon dioxide be eliminated?
Protection: can the airway limit aspiration and maintain reflex protection?

Loss of any one of these functions can destabilize a patient, even if the others are temporarily preserved.

Airway Assessment and Clinical Reasoning

Tue, 03 Mar 2026 13:00:00 -0600

¶Initial question set

At bedside, airway reasoning starts with three immediate questions:

Is the airway currently patent?
Is oxygenation adequate and stable?
Is ventilation adequate and stable?

Then add trajectory: is the patient improving, static, or deteriorating over minutes?

¶High-value exam signals

Speech: inability to complete phrases suggests significant respiratory compromise.
Sound: stridor suggests upper-airway narrowing; expiratory wheeze suggests lower-airway narrowing.
Work of breathing: accessory muscle use, retractions, or paradoxical breathing increases concern.
Mental status: agitation, somnolence, or confusion in respiratory distress is a danger sign.
Secretions and emesis: raise aspiration risk and procedural complexity.

¶Monitoring logic

Pulse oximetry tracks oxygen saturation, not ventilation quality. Capnography can add direct trend information for ventilation and is important when confirming advanced airway placement.

Airway Treatment Principles

Tue, 03 Mar 2026 13:00:00 -0600

¶Principle 1: Oxygenation first

In acute airway compromise, immediate priority is maintaining oxygenation while preparing definitive treatment. Preoxygenation and early recognition of failure risk are core safety steps.

¶Principle 2: Use a staged escalation

A common escalation pathway is:

Basic maneuvers: positioning, jaw support, and secretion clearance.
Basic adjuncts: oral or nasal adjuncts when appropriate.
Assisted ventilation: bag-mask support when spontaneous ventilation is inadequate.
Advanced airway: tracheal intubation when indicated.
Rescue pathways: supraglottic airway and, if required, emergency front-of-neck access in cannot-intubate/cannot-oxygenate scenarios.

The core safety idea is to protect oxygenation at every stage instead of pursuing repeated failed attempts at one technique.

Common Airway Illnesses and Syndromes

Tue, 03 Mar 2026 13:00:00 -0600

¶Upper-airway dominant patterns

¶Anaphylaxis

Rapid edema and bronchospasm can combine to threaten airway, breathing, and circulation. Early epinephrine plus airway support is central.

¶Foreign-body airway obstruction

Acutely blocks airflow and can progress to complete obstruction. Immediate recognition and protocol-based response are time-critical.

¶Epiglottitis and severe supraglottic infection

Can cause rapidly progressive upper-airway obstruction. Modern incidence changed after H. influenzae type b vaccination, but severe cases still occur and require urgent specialist management.