Pre-Hospital Airway Management

Airway management is the most critical intervention in pre-hospital care. Hypoxia kills quickly. As a Basic Level provider, your primary goal is to recognize airway compromise and establish a patent airway using basic maneuvers and adjuncts before progressing to advanced techniques.

Anatomy of the Airway

The upper airway consists of the mouth, nose, pharynx, and larynx. The most common cause of airway obstruction in an unconscious patient is the tongue falling back against the posterior pharyngeal wall due to loss of muscle tone.

Upper Airway Anatomy

Interactive Atlas

Selected Landmark

Nasal Cavity

Highly vascularized pathway that warms and filters inspired air.

Tactical Clinical Pearl

"NPA insertion route. Must lubricate heavily and insert straight back along the nasal floor with the bevel facing the septum to prevent severe epistaxis."

Critical Caution

Avoid NPA in suspected basilar skull fractures to prevent accidental intracranial entry.

Nasal CavityOral Cavity & TongueEpiglottisLarynx & Vocal CordsTrachea

FIGURE: Observe the relationship between the tongue, epiglottis, and trachea.

Recognizing Airway Obstruction

Do not rely solely on pulse oximetry (SpO2) to assess the airway. SpO2 is a late indicator of hypoxia. Instead, use the Look, Listen, Feel approach:

• Look: Agitation (early hypoxia), depressed consciousness (late hypoxia), cyanosis, accessory muscle use, seesaw breathing.
• Listen:
  • Snoring: Tongue obstruction.
  • Gurgling: Fluid (blood, vomit, secretions) in the airway.
  • Stridor: High-pitched sound indicating upper airway narrowing (e.g., anaphylaxis, burns).
  • Silence: Complete obstruction. This is an immediate life threat.
• Feel: Airflow against your cheek.

Basic Airway Maneuvers

Before using equipment, utilize manual techniques to open the airway.

1. Head-Tilt / Chin-Lift: The standard maneuver for medical patients.
2. Jaw Thrust: The mandatory maneuver for trauma patients with suspected cervical spine injuries. It lifts the tongue away from the posterior pharynx without extending the neck.

Basic Airway Adjuncts

If manual maneuvers are insufficient or cannot be maintained, use basic adjuncts.

Oropharyngeal Airway (OPA)

• Indication: Unconscious patients with NO gag reflex.
• Sizing: Measure from the center of the mouth (incisors) to the angle of the jaw.
• Insertion: Insert upside down, then rotate 180 degrees once past the soft palate.

Nasopharyngeal Airway (NPA)

• Indication: Patients with a reduced level of consciousness who still have an intact gag reflex, or patients with trismus (clenched teeth).
• Sizing: Measure from the tip of the nose to the earlobe.
• Insertion: Lubricate heavily. Insert straight back along the floor of the nasal cavity with the bevel facing the septum.