Key Takeaways
- The upper airway consists of the nasal cavity, pharynx (nasopharynx, oropharynx, laryngopharynx), and the larynx.
- The epiglottis is a leaf-shaped cartilage that prevents food and liquid from entering the trachea during swallowing.
- Airway assessment uses the look, listen, and feel approach to determine adequacy of breathing.
- Signs of adequate breathing include a regular rate (12-20 breaths/min in adults), equal bilateral chest rise, and clear breath sounds.
- Signs of inadequate breathing include abnormal rate, shallow depth, irregular rhythm, cyanosis, and use of accessory muscles.
- Head-tilt/chin-lift is the primary airway maneuver for patients without suspected spinal injury.
- Jaw-thrust maneuver is used when cervical spine injury is suspected to open the airway without moving the neck.
- Snoring, gurgling, stridor, and silence are key airway sounds that indicate different levels of obstruction.
Upper Airway Anatomy & Assessment
The airway is the most critical system for an EMT to understand. Without a patent (open) airway, no other intervention matters. The upper airway warms, filters, and humidifies air before it reaches the lungs.
Anatomy of the Upper Airway
Nasal Cavity
The nasal cavity is the primary entry point for air during normal breathing. It contains turbinates (bony shelves) that warm, humidify, and filter inhaled air. The nasal cavity is lined with mucous membranes and tiny hairs (cilia) that trap particles and pathogens.
Pharynx
The pharynx (throat) is a muscular tube that serves as a shared pathway for air and food. It is divided into three regions:
| Region | Location | Function |
|---|---|---|
| Nasopharynx | Behind the nasal cavity | Air passage only; contains adenoids |
| Oropharynx | Behind the mouth | Shared air and food passage; contains the tongue base |
| Laryngopharynx | Below the oropharynx, above the larynx | Divides into the trachea (airway) and esophagus (food) |
Epiglottis
The epiglottis is a leaf-shaped flap of elastic cartilage located at the base of the tongue. During swallowing, it folds over the glottic opening (the entrance to the trachea) to prevent aspiration of food and liquids. When the epiglottis fails to function properly, aspiration can occur.
Larynx
The larynx (voice box) is the transition point between the upper and lower airways. It contains the vocal cords, which vibrate to produce sound. The larynx is protected by the thyroid cartilage (Adam's apple) and the cricoid cartilage, the only complete cartilage ring in the airway.
Airway Assessment: Look, Listen, Feel
Assessing the airway is the first priority in any patient encounter. Use the look, listen, feel approach:
- Look: Observe for chest rise and fall, use of accessory muscles, nasal flaring, retractions, and skin color changes (cyanosis).
- Listen: Listen for abnormal airway sounds — snoring (tongue obstruction), gurgling (fluid in the airway), stridor (upper airway narrowing), or wheezing (lower airway constriction).
- Feel: Place your cheek or hand near the patient's mouth and nose to feel for air movement.
Signs of Adequate vs. Inadequate Breathing
| Feature | Adequate Breathing | Inadequate Breathing |
|---|---|---|
| Rate | 12-20 breaths/min (adult) | Too fast (>24) or too slow (<8) |
| Depth | Normal tidal volume (~500 mL) | Shallow or excessively deep |
| Rhythm | Regular | Irregular |
| Breath sounds | Clear and equal bilaterally | Diminished, absent, or noisy |
| Chest expansion | Symmetric rise and fall | Asymmetric or minimal |
| Skin color | Normal | Pale, cyanotic, or mottled |
| Accessory muscles | Not used | Visible use of neck, chest, or abdominal muscles |
| Mental status | Alert, oriented | Altered, anxious, confused |
Airway Maneuvers
Head-Tilt/Chin-Lift
This is the default maneuver for opening the airway in patients without suspected spinal injury:
- Place one hand on the patient's forehead and apply firm, gentle backward pressure to tilt the head back.
- Place the fingertips of the other hand under the bony part of the chin and lift it forward.
- Do NOT press on the soft tissue under the chin, as this can obstruct the airway.
Jaw-Thrust Maneuver
This technique is used when cervical spine injury is suspected:
- Kneel above the patient's head.
- Place your fingers behind the angles of the lower jaw on both sides.
- Push the jaw forward (anteriorly) without tilting the head.
- This moves the tongue away from the posterior pharynx, opening the airway while maintaining spinal alignment.
Which structure prevents food and liquid from entering the trachea during swallowing?
An EMT arrives on scene and finds an unresponsive patient who fell from a ladder. Which airway maneuver should be performed first?
A patient is making a snoring sound with each breath. This most likely indicates:
The cricoid cartilage is significant in airway management because it is:
Which of the following is a sign of inadequate breathing in an adult patient?
Which of the following are signs of INADEQUATE breathing in an adult? (Select all that apply)
Select all that apply