Chapter 9 Airway Management: Critical Thinking Exercises

Critical Thinking Exercises
Airway assessment is a critical skill. The purpose of this exercise will be to consider how you might assess and manage patients with signs of an airway problem.
1. On arrival at the emergency scene, you find an adult female patient with gurgling sounds in the throat and inadequate breathing slowing to almost nothing. How do you proceed to protect the airway?
2. When evaluating a small child, you hear stridor. What does this sound tell you? What are your immediate concerns regarding this sound?
3. When assessing an unconscious patient, you note snoring respirations. Should you be concerned with this and, if so, what steps can you take to correct this situation?

Pathophysiology to Practice

The following questions are designed to assist you in gathering relevant clinical information and making accurate decisions in the field.
• Describe the signs of a partially obstructed airway.

• Describe how an altered mental status might impact the air-way of your patient.

• Describe why trauma to the neck might be both an immediate and an ongoing threat to the airway.

Answers

Critical Thinking Exercises

1. This patient needs immediate airway intervention, including suctioning, positioning, and potentially the insertion of an airway adjunct. Further treatment will include positive pressure ventilation and probably advanced life support assistance.

2. Stridor indicates a partially obstructed airway. Your immediate concern is the threat of the airway occluding completely. Rapid transport is necessary.

3. Snoring respirations indicate turbulent airflow through the airway. In an injured or ill patient, it generally indicates a decreased capability to maintain the airway as consciousness decreases. Corrective actions include positioning the head, opening the airway, and potentially inserting an airway adjunct.

Pathophysiology to Practice

1. The signs of a partially obstructed airway include difficulty breathing, difficulty speaking, stridor, snoring, choking, and coughing.

2. An altered mental status can impact the patient’s airway because as mental status decreases, control of the muscles that keep the airway open can be impaired. The loss of tone in these muscles can lead to the epiglottis falling back and obstructing the glottic opening. Altered mental status can also cause a loss of the gag reflex. Without this protective reflex, patients are at risk for aspiration.

3. Neck trauma can immediately impact the airway by disrupting pathways and destroying structures, but it might also threaten long-term patency by causing swelling to occur in the airway passages. This swelling can obstruct the movement of air.

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