Airway obstructions are a common emergency, especially among pediatric and geriatric patients. Choking is a common hazard and a prominent cause of childhood death and injury among children under age four claiming at least one child’s life every few days. In the case of geriatric patients, the risk of airway obstructions due to chronic obstructive pulmonary disease (COPD), pneumonia, and airway injuries greatly increases with age. The airway also becomes more fragile as a person gets older, making it more difficult to treat airway issues. A number of techniques can open an obstructed airway, but the right technique depends on the reason for the obstruction.
Basic Airway Management
A number of basic airway management techniques can help open an obstructed airway, or even prevent it in the first place. Try lifting the chin in a patient who is lying down. In many scenarios, the tongue is the primary source of the obstruction. For a choking patient who cannot breathe, cough, or clear their own airway, abdominal thrusts and back blows are the first line of defense. If you can see the airway obstruction and safely access it, a throat sweep to remove it can also help. If these basic airway management strategies fail, you’ll need to progress to advanced techniques such as suctioning the airway.
Medication
Certain airway medications may help open an obstructed airway, especially due to allergic anaphylaxis. Epinephrine and related medications help immediately reverse swelling and inflammation. If a patient has asthma or another chronic condition, ask about the use of rescue inhalers or other prescription medications. Drugs the patient has previously used are less likely to induce side effects and allergic reactions.
Suctioning
Suctioning the airway can remove secretions that the patient cannot clear on their own, prevent or reverse aspiration, and in some cases remove foreign objects.
Intubation
Intubation allows you to oxygenate a patient who cannot breathe on their own because of an airway obstruction, trauma, or other emergency. The right intubation procedure depends on the patient’s anatomy, the cause of the obstruction, and similar factors.
Surgical Procedures
Sometimes it is impossible to safely intubate a patient using normal measures. Obstructions lower in the airway and large objects lodged in the trachea can make it impossible to breathe, while rendering standard intubation techniques unsafe. Surgical intubation, such as via a cricothyrotomy, can help a patient breathe until you are able to address the underlying cause of the airway obstruction. In some cases, cricothyrotomy is a longer-term solution for chronic airway obstructions.
SALAD Technique
Rapid suctioning can help prevent aspiration. But what if a patient is bleeding from the airway or actively vomiting? This demands a more aggressive technique. Suction-assisted laryngoscopy and airway decontamination (SALAD) uses continuous suction to reduce the risk of aspiration and support the airway. The DuCanto CatheterⓇ is the ideal tool for this treatment protocol.
Antibiotics
Infections such as bacterial pneumonia, infected wounds from airway trauma, and other pathogens can obstruct the airway or complicate other airway obstructions. Although antibiotics will not immediately open the airway, they can reduce the long-term risk of complications. Patients who have recently aspirated face an especially high risk of infection-related mortality, so even if you are able to clear the airway, it’s important to transport them for evaluation so they can get the right antibiotics.
The right airway management equipment can save lives. Make sure your bag is fully stocked with emergency drugs, catheters, and tubing in a variety of sizes, as well as a portable emergency suction machine. Portable suction ensures that you can quickly tend to patients without moving them or delaying treatment. For help choosing the right machine for your agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
Editor's Note: This blog was originally posted on April 2020 and has since been updated with new content.