Airway

Signs of breathing difficulties

• Dyspnoea, tachypnoea, apnoea
• Intercostal use
• Seesaw breathing - in-drawing of chest during inspiration, which occurs due to intercostal use
• Inability to speak in complete sentences
• Wheezing
• Central cyanosis
• Sweating and tachycardia
• Agitation or decreased LoC

Golden rules in airway compromise:

1. Give oxygen in highest concentration possible
   1. Don't worry about depressing hypoxic drive to breathe - hypoxia kills people quicker
2. Use simple methods first
3. Call for help early

Administering oxygen:

1. If breathing, Hudson mask with reservoir
2. If not breathing or not breathing well, bag/valve/mask
3. Apply pulse oximetry at the same time to assess whether it is actually working
4. Turn oxygen down once sats are at an appropriate level and patient is stable

Airway support escalation:

1. Chin lift/jaw thrust
2. Suction
3. OPA (Guedel - size from tragus of ear to angle of mouth) or NPA (if they still have a gag reflex)
4. Laryngeal mask or ETT
5. Surgical airway

• If basic manoeuvres aren't working, the patient needs OPA/NPA. If they tolerate OPA, you need someone with advanced airway skills there immediately.

Tracheostomy:

• See separate topic under 'head and neck'

Extubation criteria

• Stable medical condition
  • Cause of respiratory failure has improved
  • Adequate ventilatory and cardiovascular function
  • Able to initiate an inspiratory effort
• Successful weaning trial
• Ability to protect airway - sufficient cough strength and adequate level of consciousness
• Low risk for post-extubation stridor