4 Airway Management
Learn how to recognize airway threats, take initial steps to maintain or clear the airway, suction safely, and escalate care effectively.
Recognizing airway threats
Assess by listening to the patient’s voice and breathing sounds, and watching for secretions or increased breathing effort. Gurgling can indicate fluid or secretions in the airway and should be treated as a possible obstruction. Address immediate airway threats first, call for assistance, take appropriate steps to clear the airway, and reassess after intervention.
The ABCDE approach prioritizes airway problems. Follow local protocols and seek help early whenever the airway may be threatened.
Escalating a threatened airway
New , increasing work of breathing, and a hoarse voice may signal upper-airway narrowing. Treat suspected obstruction as an emergency: call for urgent expert help and prepare to support oxygenation while the airway is assessed.
Do not rely on an acceptable oxygen-saturation reading to dismiss these signs, and do not wait for cyanosis before escalating; cyanosis is a late sign. If the airway is worsening despite initial measures, escalate without delay.
Assessing and suctioning secretions
Suction when assessment suggests retained secretions, rather than following a fixed schedule or suctioning solely to prevent possible future buildup. Findings that support suctioning a patient with an endotracheal tube include visible secretions, coarse airway sounds, or a ventilator waveform suggesting retained secretions, such as a sawtooth waveform.
Before suctioning, preoxygenate the patient. Limit each suction application to no more than 15 seconds per procedure. Routine normal-saline instillation should generally be avoided. Monitor the patient’s response and stop if significant intolerance occurs.
Opening the airway with possible neck injury
For an unresponsive patient with suspected cervical-spine trauma and signs of airway obstruction, use a while maintaining spinal alignment. When trauma is not suspected, use head tilt–chin lift. Follow local emergency protocols and escalate if the airway remains compromised.
Communicating deterioration
When contacting the rapid-response or airway team about worsening airway status, give a concise report. Include the patient’s current situation, relevant background, assessment findings, and a clear statement of what help is needed.
Use local activation criteria, and do not delay escalation when concerned about a threatened airway.