Airway: Obstruction, Patency, Assessment, Intervention, and Management

Table of Contents :

1. Introduction
2. What is Airway Obstruction?
3. Types of Airway Obstruction
4. Airway Patency
5. Airway Assessment
6. Airway Interventions
7. Advanced Airway Management
8. Airway Management in Special Populations
9. Airway Management in Emergencies
10. Long-Term Management of Airway Issues
11. Wrapping Up

 

Airway obstructions are becoming increasingly common general in the population, resulting in fatal consequences. The leading cause of accidental death, especially in children under five and older adults, is choking due to airway obstruction. This could be caused by a piece of food, the tongue blocking the throat, or swelling due to an allergic reaction.

Once you know how to assess and manage airway issues, you can save lives in respiratory emergencies. Thus, knowing what to do in an emergency is critical to managing simple or severe airway obstruction. In this blog, we’ll explore the causes of airway obstruction, how to assess the airway, and the steps you can take to ensure the airway remains open and clear.

 

What is Airway Obstruction?

Airway obstruction occurs when something blocks or narrows the passages that allow air to move from the mouth and nose to the lungs. This can be partial or complete and can happen at different points in the airway. 

If you are wondering, what is the most common cause of airway obstruction? Then, it is an obstruction of foreign objects, such as food. For example, a piece of bread can become lodged in the throat, blocking the windpipe and making it impossible to breathe. In addition, the two main types of airway obstruction based on their consequences are: 

• Mild Airway Obstruction: When the blockage isn’t completely cutting off air, the person can still breathe and cough but might be uncomfortable. This is often less urgent but still requires monitoring.
• Severe Airway Obstruction: This occurs when the blockage is significant and prevents air from passing at all. It’s a medical emergency that needs immediate action.

 

Types of Airway Obstruction

Airway obstructions can happen in different parts of the respiratory system, which makes it difficult to breathe. These blockages can occur in the upper or lower airway and are due to various causes. Below, we’ll break down the types of airway obstructions.

1. Upper Airway Obstruction

The upper respiratory tract consists of the mouth, throat, or trachea (windpipe). Any obstruction in these structures can cause the individual to grasp for air or even severe choking. Some of the main causes are as follows:

• Tongue falling back is especially common when someone is unconscious, as the tongue may relax and block the airway.
• Foreign objects such as food, toys, or even dental appliances.
• Swelling can occur from allergic reactions (anaphylaxis) or infections like tonsillitis.
• Injury or trauma can cause damage to the neck or face and can cause swelling or collapse of the airway.
• When food or liquids enter the airway instead of the esophagus (food pipe).

2. Lower Airway Obstruction

This type of obstruction occurs deeper in the respiratory system, usually in the bronchi (large air passages) or smaller airways inside the lungs. Some common causes include:

• Asthma causes swelling and narrowing of the airways due to inflammation.
• Chronic Obstructive Pulmonary Disease (COPD) results in Long-term damage that blocks airflow.
• Bronchitis affects the bronchi, leading to inflammation and mucus build-up.

 

Airway Patency

Airway patency refers to how open and clear the airway is. An airway with good patency allows air to move freely in and out, while an obstructed or compromised airway restricts airflow. The following signs can help analyze airway patency: 

• Normal Breathing Sounds: You can hear air moving in and out of the lungs clearly.
• Clear Speech: If a person can talk without difficulty, it usually means their airway is open.
• Normal Skin Color: There are no signs of cyanosis (blue skin, especially around the lips), which indicates a lack of oxygen.
• No Visible Distress: The person appears comfortable and isn’t showing signs of struggling to breathe.

Now, what is a sign of severe airway obstruction? The signs of a compromised airway are: 

• Noisy Breathing: Stridor (high-pitched wheezing) or gurgling may indicate an obstruction.
• Inability to Speak: If someone can’t speak or cough, their airway might be blocked.
• Cyanosis: A bluish tint to the skin, particularly around the lips, is a sign of insufficient oxygen.
• Use of Accessory Muscles: Struggling to breathe by using neck and chest muscles.

 

Airway Assessment

Comprehensive airway assessment is important to ensure that the airway is patent or to identify any obstruction that could prevent respiration. Using a systematic approach helps healthcare providers or bystanders quickly identify whether the airway is patent or obstructed and take immediate action.

• Check for Responsiveness: If the person is conscious, ask them simple questions to see if they can speak. If they can talk, the airway is likely open. If the person is unconscious, check for other signs of airway obstruction, such as noisy or absent breathing.
• Look, Listen, and Feel: Look for chest rise. If the chest moves normally with each breath, the airway may be patent. Listen for any abnormal breathing sounds, like gurgling, wheezing, or stridor. Feel for air movement by placing your cheek near the person’s mouth and nose while watching their chest rise.
• Check for Foreign Objects: Quickly inspect the mouth for anything that could block the airway, such as food or dentures.
• Monitor Breathing Rate and Depth: Normal adults breathe about 12-20 times per minute. Any rate outside this range could indicate respiratory distress.

 

Airway Interventions

Once a thorough airway assessment is conducted, the first responder or healthcare professional needs to identify the correct intervention to remove airway obstructions. The choice of intervention depends on the cause and location of the obstruction.

1. Simple Interventions:

• Head Tilt-Chin Lift Maneuver: This technique helps open the airway in an unconscious person by tilting the head back and lifting the chin. It’s useful when the tongue is blocking the airway.
• Jaw Thrust Maneuver: If there is a suspicion of neck injury, the head should not be tilted. Instead, the jaw thrust technique moves the jaw forward to open the airway without moving the neck.

2. Clearing Foreign Objects:

• Heimlich Maneuver (Abdominal Thrusts): If someone is choking on a foreign object, the Heimlich maneuver can force the object out by applying upward abdominal pressure.
• Back Blows and Chest Thrusts (For Infants): Firm back blows followed by chest thrusts can help dislodge an obstruction in infants.

3. Airway Adjuncts:

• Oropharyngeal Airway (OPA): This device keeps the airway open by preventing the tongue from blocking it. It is inserted into the mouth in unconscious patients.
• Nasopharyngeal Airway (NPA): This tube is inserted into the nose to maintain an open airway, especially when the mouth cannot be accessed or there is a risk of gagging.

If fluids like blood, mucus, or vomit are blocking the airway, suction devices can remove them.

Read More: Complete Guide to First Aid Kits: Contents, Types, and Usage

 

Advanced Airway Management

In situations where basic interventions do not work, advanced airway management becomes necessary. These include endotracheal intubation, LMA, and cricothyrotomy:

• Endotracheal Intubation: This is the insertion of a tube into the trachea (windpipe) to secure the airway. It’s commonly used in surgeries or emergencies where the patient cannot maintain their airway.
• Laryngeal Mask Airway (LMA): The LMA is placed over the opening of the trachea. It is often used in surgeries or when intubation is difficult.
• Cricothyrotomy: In extreme emergencies where the upper airway is completely blocked, a surgical procedure called cricothyrotomy may be performed. This involves making an incision in the neck to insert a tube directly into the windpipe.

 

Airway Management in Special Populations

Airway management can vary based on the patient’s age and condition. Special populations like children, trauma patients, and those with obstructive sleep apnea (OSA) need tailored approaches to keep their airways clear. Below are some considerations for managing airways in these groups:

• Children

Children are more prone to airway obstruction due to their smaller airways. Therefore, extra care must be taken during airway management, as their airways are more delicate. Techniques like back blows and chest thrusts are used instead of the Heimlich maneuver in infants.

• Trauma Patients

Airway management in trauma patients can be tricky due to potential injuries to the neck and face. Without moving the neck, the jaw thrust maneuver is used to open the airway. Additionally, securing the spine during airway management is crucial.

• Patients with Obstructive Sleep Apnea (OSA)

People with OSA have blocked airways during sleep due to the relaxation of the throat muscles. They often require continuous positive airway pressure (CPAP) devices to keep their airways open during sleep.

Read More: 5 Key Reasons Basic Life Support Training is Essential

 

Wrapping Up

In emergencies, having the knowledge and skills to manage an airway obstruction can be life-saving. Airway obstruction, whether caused by choking, swelling, or other factors, is a serious issue that can quickly turn dangerous. Once you know how to assess the airway, recognize the signs of blockage, and know the steps to intervene, you can ensure that air flows properly and the person gets the oxygen they need. 

For those who want to be prepared for emergencies, learning these skills through a Basic Life Support (BLS) course is essential. A BLS course will teach you how to manage airway issues, perform CPR, and use life-saving equipment like an AED. These are vital skills that everyone should know to respond confidently in critical situations. Sign up for a BLS course today and start learning!