Assessing airway & ventilation


So here is some thoughts around the questions.

Airway management and ventilatory support is fundamental for treating all critically ill and injured patients.

We must be good at assessing the level of compromise. It defines the rest of the patient management at all levels and the bad management will result in … yes real badness very quickly.

Compromised airway

DO NOT skip the initial look and listen after correct positioning (head tilt/chin lift, jaw thrust or the sniffing position).
* Dr. Ellis would like to see the sniffing position to be known more widely and used earlier in the airway management. We will talk more on the next post.

In unconscious patients, gag reflex used to be taught as an ability to maintain airway but is no longer recommended for the obvious reason. Well who would try gagging sick patients anyway???


Instead, looking at the back of throat (if unconscious) for inability to swallow (having pool of saliva, blood etc) is a good indicator for the patient unable to maintain airway.

3 things to look for when assessing obstructive airway compromise are;

  1. Hot potato voice…what a ?? or muffled sound voice
  2. Inability to swallow
  3. Stridor (imminent)

Reference; Walls & Murphy “Manual of Emergency Airway Management”

Compromised ventilation

Along with airway, the initial look, such as skin colour, ALOC, chest movement etc, will give you some clues for the ventilatory compromise, but here is an additional assessment tool taught by Dr. Ellis.

  1. GCS < 10
  2. SPO2 < 90%
  3. Respiratory rate <8 or >30
  4. ETCO2 > 45

Airway vs ventilation

This is just a quick reminder that, although synergistic and taught together, airway and ventilation are two totally separate entities and they are not synonymous.  Poor airway will more than likely compromise ventilation but not always, and bad ventilation will probably result in positive O sign  despite having good airway.

Catch you again next week!



3 Comments Add yours

  1. Tatsu Kuwasaki says:

    Here is a comment from Mark…

    Hey Tatsu….Good job on all the work you are doing.
    Measuring airway compromise….In a surfer with what sounds like a anaphylactic issue.
    Gather immediate history & medical history to help in assessment.
    1) patient position, pulse rate..sitting , standing, tripod, use of accessory muscles, pursed lips.
    2) Respiratory rate, depth of breathing, chest rise and fall, words per breath.
    3) Audible noises, auscaltation noises,,wheezes, whistles, stridor, crackles.
    4) Patient colour…pale, mottled, cyanosed..Flushed (hypercarbic)
    5) Facial expression..anxious..drowsy..agitated.
    6) Mental status lowered GCS
    7) lifepak assistance…Spo2… Capanogrophy.. via endtidal sensor plugged into neb…. electrical heart rate.
    8) If suspecting lung collapse…percussion… midline shift…chest symmetry.

    Probably been bitten by a peanut fish!

    Cheers Mark


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