Advanced Airway Management in BLS

As a healthcare provider, you are expected to perform more advanced airway management techniques than lay rescuers. Ensuring proper oxygenation and ventilation is critical for patient survival, especially in cases of respiratory arrest.

Key Concepts in Airway Management

• Ensuring an open airway using the correct maneuvers
• Using a bag-mask device (BVM) to provide high-quality ventilations
• Employing airway adjuncts (oropharyngeal & nasopharyngeal airways) to maintain airway patency
• Minimizing ventilation interruptions to support high-quality CPR

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Opening the Airway

Head Tilt-Chin Lift vs. Jaw Thrust

Proper airway positioning is the first step in effective ventilation.

• Use the Head Tilt-Chin Lift for patients without suspected spinal injury.
• Use the Jaw Thrust Maneuver if spinal injury is suspected (e.g., trauma patients).

Regardless of the maneuver used, ensure:

• The tongue is not obstructing the airway.
• There is no visible foreign body blocking the airway.
• Rescue breaths result in visible chest rise.

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Bag-Mask Ventilation (BVM)

1. Proper Technique

Bag-mask ventilation (BVM) is the preferred method for providing assisted breaths in a healthcare setting. To ensure effective ventilation:

1. Position yourself directly above the patient’s head.
2. Use the E-C Clamp Technique:
   • Place your thumb and index finger around the mask (forming a “C”).
   • Use your remaining three fingers to lift the jaw (forming an “E”).
3. Squeeze the bag over 1 second per breath while observing chest rise.
4. Avoid over-ventilating, as excessive volume can cause gastric inflation and reduce cardiac output.

2. Common Mistakes & How to Fix Them

• Poor mask seal → Adjust hand positioning (E-C clamp), reposition the mask, or use two hands.
• Insufficient chest rise → Reassess airway positioning, check for obstructions, or reposition the head.
• Gastric inflation → Reduce breath volume and pressure; ensure slower, controlled breaths.

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Airway Adjuncts: OPAs & NPAs

1. Oropharyngeal Airway (OPA)

The oropharyngeal airway (OPA) helps maintain airway patency by preventing the tongue from blocking airflow.

When to Use an OPA:

• Unresponsive patients without a gag reflex
• When bag-mask ventilation is required

How to Insert an OPA:

1. Measure from the corner of the mouth to the earlobe for correct sizing.
2. Insert the OPA upside down (curved side up).
3. Rotate 180 degrees as it passes the soft palate.
4. Ensure proper fit and reassess airway patency.

When NOT to Use an OPA:

• If the patient has an intact gag reflex (risk of vomiting and aspiration)

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2. Nasopharyngeal Airway (NPA)

The nasopharyngeal airway (NPA) is an alternative airway adjunct, especially useful when an OPA cannot be tolerated.

When to Use an NPA:

• Patients with a gag reflex who need airway support
• Patients with jaw trauma where OPA insertion is not possible

How to Insert an NPA:

1. Measure from the tip of the nose to the earlobe for correct sizing.
2. Lubricate the NPA with a water-based lubricant.
3. Insert the airway into the right nostril (bevel facing the septum) and advance gently.
4. Ensure proper placement and reassess airway patency.

When NOT to Use an NPA:

• Patients with suspected basilar skull fracture (risk of intracranial insertion)
• Severe nasal trauma or obstruction

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Minimizing Interruptions While Maintaining Effective Ventilation

• Coordinate ventilations with chest compressions to reduce “no flow” time.
• Use a **two-person BVM technique** when possible for better airway control.
• Monitor for **chest rise** to confirm effective breaths.

By mastering airway techniques, healthcare providers can ensure proper oxygenation while minimizing interruptions in CPR.