BACHELOR OF SCIENCE IN NURSING:

CRITICAL CARE NURSING
COURSE MODULE COURSE UNIT WEEK
7 2 8

AIRWAY OBSTRUCTION AND AIRWAY MANAGEMENT

ü Read course and unit objectives

ü Read study guide prior to class attendance
ü Read required learning resources; refer to unit
terminologies for jargons
ü Proactively participate in classroom discussions
ü Participate in weekly discussion board (Canvas)
ü Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive:
1. Identify the different techniques in maintaining a patent airway
2. List down the indications of the different airway management

Affective:
1. Listen attentively to the discussions and opinions in the class
2. Initiate asking questions that challenge class thinking
3. Express freely the personal opinion with respect to others opinion

Psychomotor:

 
 1. Participate actively during class discussions
2. Confidently express personal opinion and thoughts in front of the class

 
Chulay, Marianne, Burns Suzanne (2011) . AACN Essentials of Critical Care
Nursing (2nd edition). International: McGraw-Hill Medical

AIRWAY OBSTRUCTION AIRWAY MANAGEMENT

DEFINITION

AIRWAY OBSTRUCTION
An airway obstruction is a blockage in any part of the airway. The airway is a complex system of
tubes that conveys inhaled air from your nose and mouth into your lungs. An obstruction may
partially or totally prevent air from getting into your lungs.

Mechanism of airway obstruction (A) fluid secretion present within airway. (B) intraluminal edema
narrowing airway diameter. (C) peribronchial compression of airway lumen example is excessive
secretion or fluid in the airways, inhaled foreign bodies), (2) increase airway wall thickness
example is edema or fibrosis) or decrease airway circumference (eg, bronchoconstriction) as
occurs in asthma, or (3) increase peribrochial compression of the airway.
(Eg, enlarge lymph nodes, interstitial edema,) tumors.

Types of airway obstructions

The types of airway obstructions are classified based on where the obstruction occurs and how
much it blocks:

• Upper airway obstructions occur in the area from your nose and lips to your larynx (voice
box).
• Lower airway obstructions occur between your larynx and the narrow passageways of
your lungs.
• Partial airway obstructions allow some air to pass. You can still breathe with a partial
airway obstruction, but it’s difficult.

 
 • Complete airway obstructions don’t allow any air to pass. You can’t breathe if you have a
complete airway obstruction.
• Acute airway obstructions are blockages that occur quickly. Choking on a foreign object
is an example of an acute airway obstruction.
• Chronic airway obstructions occur two ways: by blockages that take a long time to
develop or by blockages that last for a long time.

Causes an airway obstruction

The classic image of an airway obstruction is someone choking on a piece of food. But that’s only
one of many things that can cause an airway obstruction. Other causes include: inhaling or
swallowing a foreign object, small object lodged in the nose or mouth, allergic reaction, trauma to
the airway from an accident vocal cord problems, breathing in a large amount of smoke from a fire,
viral infections, bacterial infections, respiratory illness that causes upper airway inflammation
(croup), swelling of the tongue or epiglottis, abscesses in the throat or tonsils, collapse of the
tracheal wall (tracheomalacia), asthma, chronic bronchitis, emphysema, cystic fibrosis, COPD.

Symptoms of an airway obstruction

The symptoms of an airway obstruction depend on the cause. They also depend on the location of
the obstruction. Symptoms you may experience include: agitation, cyanosis (bluish-colored skin),
confusion, difficulty breathing, gasping for air, panic, high-pitched breathing noises such as
wheezing, unconsciousness.

AIRWAY MANAGEMENT

1. Oropharyngeal Airway

• Also known as Oral bite block

• Temporary
• Relieves upper airway obstruction
– Tongue relaxation, secretions, seizures
• Not recommended for alert clients
– May trigger gag and cause vomiting
• Nursing Responsibility
– Frequent assessment of the lips and tongue to identify pressure areas
– Removed at least q 24 hours to check for pressure areas and to provide oral hygiene

 
2. Nasopharyngeal Airway

• AKA Nasal trumpet

• Maintains airway patency
• Also used to facilitate nasotracheal suctioning
• Usually 26-35 french
• Complication
• Bleeding
• Sinusitis
• Erosion of the mucus membranes
• Nursing Responsibility
• Assessment of the pressure areas and occlusion due to secretions
• Rotation of tube from nostril to nostril daily

3. Laryngeal Mask Airway

• An ET with a small mask on one end that can be passed orally over the larynx
• Provides ventilatory assistance and prevent aspiration

 
4. Combitube

• Esophageal/tracheal double lumen airway

• Used for difficult or emergency intubation
• Permits blind placement

5. Artificial airway device

for use in place of an endotracheal tube to facilitate lung ventilation in an unconscious patient, is in
the form of a laryngeal mask comprising a tube opening into the interior of a mask portion whose
periphery, which may be inflatable, is adapted to seal around the inlet to the larynx, thus securing
the patient's airway, permitting spontaneous or controlled ventilation and preventing inhalation of
extraneous matter.

 
Endotracheal Tube

• Includes a 15mm adapter at the end for connection to life support equipment
• Distance marker on the sides for placement
• Inserted into the trachea through the mouth or nose

Insertion

• W/ laryngoscope to visualize the upper airway

• Inserted through the vocal cords into the trachea
– 2-4 cm above the carina
• Confirm proper placement
– Presence of bilateral breath sounds
– Equal
– Absence of breath sounds over the stomach
– PETCO2: 35-40 mmHg
• Verification: CXR
• Anchor with tape or ET fixation device
• Centimeter marking at the lip is documented during each shift
• 10-14 days of intubation: tracheostomy is usually indicated
• Complications:
– Laryngeal and tracheal damage
– Laryngospasm
– Aspiration
– Infection and discomfort

Suctioning
• 2 methods
– Closed suctioning
• Ventilator circuit is closed
– Open suctioning
• Ventilator circuit is opened or removed

Indication of suctioning
• Coughing or visible secretions
• Increased ventilatory pressure
• Adventitious breath sounds
• Assessment of airway patency
• Respiratory distress

 
ET (Endotracheal tube) - An endotracheal tube is a flexible plastic tube that is placed through the
mouth into the trachea (windpipe) to help a patient breathe. The endotracheal tube is then
connected to a ventilator, which delivers oxygen to the lungs. The process of inserting the tube is
called endotracheal intubation.

Suctioning is 'the mechanical aspiration of pulmonary secretions from a patient with an

artificial airway in place'. Suction is used to clear retained or excessive lower respiratory
tract secretions in patients who are unable to do so effectively for themselves.

Reading assignment Basic electrophysiology Chapters 3. 2nd edition AACN Essentials of Critical
Care Nursing by Marianne Chulay and Suzanne M. Burns

https://www.verywellhealth.com/endotracheal-tube-information-2249093
https://www.physio-pedia.com/Suctioning

Study Questions

• Make a scenario of patient suffering from any cause of airway obstruction and indicate what
is the best airway management for that specific problem.

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