Basic airway management begins with opening and maintaining the airway. The main goal is to prevent the 1)_____ from blocking the airway. For a non-trauma patient a 2)_____ method is preferred. For a trauma patient the 3)_____ with spinal neutralization method is used.  If you have to pick between airway and spine always pick airway first.

Evaluating the airway is always a top priority. Normal respirations should be 4)_____, effortless, and with 5)_____ rise. Ventilatory assistance is required if the patient is breathing less than 6)_____ times per minute. A non-breathing patient should receive two slow and smooth breaths lasting 7)_____ second in length to evaluate the airway passage for a blockage.

An oropharyngeal (OPA) airway is used to help establish a patients airway when a 8)___  ___ is not present. OPA’s come in many sizes. To ensure proper size the rescuer should measure by placing one end of the device on the corner of the 9)_____ and the other end to the earlobe. To insert the OPA, hold the device at its flange end and insert it into the mouth with the tip pointing toward the roof of the patient’s mouth. Once the distal end of the OPA reaches the posterior wall of the pharynx, rotate the OPA 180 degrees so that it is positioned over the tongue. The flange should rest on the 10)_____ when properly inserted. Use of the OPA does not eliminate the need for maintaining proper head position. It is also acceptable to rotate the device at 90 degrees.

The NPA is used when the oral pharynx is not accessible or the patient has a gag reflex. The device is contraindicated in patients with 11)_____ and used with caution if 12)_____ are present. To ensure proper size the rescuer should measure from the corner of the 13)_____ to the earlobe. Lubricate the device prior to placement with a water based substance. When inserting the NPA in an emergency on should pick the largest and straightest nostril. Place the bevel of the NPA to the nasal septum. Hold the device like you would a pencil and slowly insert the NPA into the patient’s nostril until the flange is flush with the nostril. Do not force the device. Use of the OPA does not eliminate the need for maintaining proper head position.

Mouth-to-mask breathing is the preferred method of ventilating a nonbreathing patient. It is a simple one person device, and because of the two-handed mask seal it provides excellent ventilatory volumes. The device when not connected to supplemental oxygen will deliver 14)_____% oxygen to the patient. When attached to >10 LMP of supplemental oxygen the device delivers approximately 15)_____% oxygen.

The bag-valve-mask (BVM) consists of a 16)_____-way valve, 17)_____-inflating bag, 18)_____ reservoir, and a 19)_____ mask. The device delivers 20)_____% oxygen concentration with room air and once connected to high flow supplemental oxygen it can deliver up to 80 to 21)_____% oxygen concentration. The BVM technique commonly creates a poor seal around the patient’s mouth and is designed for two trained rescuers to use. The BVM typically delivers 22)_____ volume than mouth-to-mask technique. When using a BVM during a cardiac arrest the rescuer needs to be aware of the pop-off valve status because greater ventilatory pressure is usually required. This device is most effective when the patient is intubated and the BVM is attached to an endotracheal tube (ETT) because the trachea is then isolated.

If supplemental oxygen is not available, tidal volumes and inspiratory times should be approximately 23)_____mL/kg (800mL) and delivered over 1 second which is sufficient to make the chest rise.

If supplemental oxygen is available, lower tidal volumes are recommended. A tidal volume of approximately 6 to 7mL/kg (500mL) is given over 1 second. The delivery of lower tidal volumes should reduce the risk of gastric inflation and its consequences.

Sellick’s maneuver reduces gastric inflation during ventilatory efforts. By placing downward pressure on the 24)_____ cartilage the diameter of the esophagus is decreased therefore restricting the flow of air into the stomach.

If a patient’s airway is compromised by fluids, turn the victim head to one side and remove large particles. Once suction is available the remaining fluids and fine particles should be removed. For oral suctioning the pressure should be set at approximately 25)_____mmHg and suction limited to 26)_____ seconds. For tracheal suctioning the pressure should be around 27)_____ to 120mmHg and suction time limited to 28)_____ seconds. Only suction on the way out and always measure for proper advancement depth of the suction catheters.

The ETC allows ventilation of the lungs and reduces the risk of aspiration of gastric contents. The device is 29)_____ inserted to ventilate the trachea, regardless of esophageal or tracheal placement. If the tube is placed in the trachea the distal cuff is inflated with up to 15 to 20mL of air. If the ETC was placed in the esophagus inflate the proximal cuff with up to 100mL of air to seal the pharynx and inflate the distal cuff with up to 15 to 20mL of air to seal the esophagus. Air will then be directed to the trachea. Contraindications: gag reflex present, suspected 30)_____ disease, ingestion of 31)_____ substance and patients less than 32)_____ feet tall (37F or 39F size). 41F size is for 5 feet to 6 foot 7 inch patients.  37/39F is for patients that are 4 feet to 5 feet.  All patients must be over 33)_____ years of age to use.  Do not use if caustic ingestion or esophageal trauma is present.

A duel-lumen tube that allows either tracheal or esophageal placement. The PTL is blindly inserted just like the ETC. Consists of two parallel tubes of equal length and two balloon cuffs that inflate simultaneously when air is blown into the inflation port with a bag-valve device. When inflated one cuff closes the oropharynx and the other cuff secures the esophagus or trachea depending on distal placement. Contraindications: gag reflex present, patients less than 5 feet tall, patients less than 14 years old, suspected esophageal disease, and ingestion of caustic substance.

The LMA may be used as an alternative to either the endotracheal tube (ETT) or the face mask with either 36)_____ or positive-pressure ventilation. The LMA may be used as the 37)_____ airway, as a channel for an ETT, or as an option in the management of a difficult airway when intubation is unsuccessful. The device consists of a tube that is fused to a elliptical, spoon-shaped mask at a 30-degree angle. The LMA comes typically in 38)_____ sizes, number 1 through 5.  Size 39)_____ fits a 30 to 50kg pt and size 5 is for 70kg and greater. When inserted, the tube protrudes from the patient’s mouth and is connected to a ventilation device. The mask is advanced until resistance is felt. Then the mask is inflated, it provides a low-pressure seal around the laryngeal inlet. When the LMA is properly placed, the black line on the tube should rest in the midline against the patient’s upper lip. The LMA is contraindicated if a risk of aspiration exists.  Some physicians prefer to rotate the LMA 90 degrees during insertion but the standard way is directly in.  Also KY gel should be added the the distal posterior portion of the LMA.  Do not use if caustic ingestion or esophageal trauma is present.

ETT intubation is the airway of choice for all critical patients who cannot protect their own airway. Tube advancement is directly into the trachea and a cuff is inflated with up to 40)_____mL of air to secure the trachea. Advantages to ETT intubation are 41)_____ of the trachea, reduction in the risk of aspiration, eliminates the need to maintain a mask seal, direct route for tracheal suction and certain medications can be administered via the ETT. Disadvantages are that it takes more skill than other airway devices, ETT can be 42)_____ easily, and takes more equipment than other methods to secure an airway. It is also recommended to use a commercial grade tube tie device to secure the ETT.

Tube sizes:  range from 2.5 mm to 9 mm.  Size 7 to 8 for men and size 43)_____ to 7 for women.  If patient is less than 44)_____ years of age it is not recommended to inflate the cuff.

Blades:  45)_____ (Wisconsin or straight)  comes in 5 sizes.  MacIntosh is a curved blade and comes in 5 sizes.
Miller is placed on the epiglotis and lift.  MacIntosh is placed in the 46)_____ and lifted to raise the epiglottis. 

Stylet provided shape and rigidity to the ETT while placing.

Patients should be hyperventilated and well oxygenated for 47)_____ minutes at a rate of 48)_____ per minute before placement of an advance airway device. The attempt to establish the airway device should take no longer than 49)_____ seconds to complete. If the device cannot be established within 30 seconds the patient should be hyperventilated again for 2 minutes before the next attempt.

Whenever airway assistance is being provided the rescuer should ensure proper ventilation of the patient two ways: with 50)_____ confirmation techniques and 51)_____ confirmation techniques. Primary confirmation techniques include 5-point 52)_____, bilateral chest expansion, and mask or tube condensation. In secondary confirmation techniques, 53)_____ detector devices are preferred for intubation confirmation in adult cardiac arrests; end-tidal 54)_____ detectors (capnography, capnometry, capnometer) are preferred in non-cardiac 55)_____ victims.