Airway Anatomy: A Brief Review

As a paramedic or EMT, your first duty in affected person care is to safe a patent airway. Whether or not you’re putting an EOA to raise the tongue of an overdosed affected person, suctioning the oropharynx of a trauma code, or inserting an endotracheal tube for a affected person who has stopped respiratory, a radical understanding of the buildings that make up the respiratory tract is a should. Here’s a transient evaluate of airway anatomy to make sure you’re prepared for the following respiratory emergency.


Guide: Portable Emergency Suction: A Critial Tool In Avoiding Aspiration  Pneumonia


Basic Construction of the Respiratory Tract

Air enters the physique via the nostril and mouth after which makes its method via the respiratory tract and down into the lungs, the place fuel alternate takes place. The final airway buildings embody:


  • Nostril: warms, humidifies, and filters impressed air
  • Mouth: begins on the lips and ends within the oropharynx
  • Pharynx: runs from the bottom of the cranium to the decrease border of the cricoid cartilage and consists of:
    • Nasopharynx
    • Oropharynx
    • Hypopharynx
  • Larynx: incorporates the thyroid cartilage, epiglottis, vallecula, and arytenoid cartilage and ends on the trachea
  • Trachea: begins on the inferior border of the cricoid ring and ends on the carina
  • Lungs: divided into three lobes on the best and two lobes on the left, with the bronchi branching ever smaller into bronchioles, ending on the alveolar ducts


Obstruction or dysfunction of any of those buildings can result in airway compromise, which could be divided into:


  • Respiratory insufficiency happens when the affected person’s respiratory system is unable to maintain up with the conventional metabolic calls for of the physique, secondary to accidents to the pinnacle, thorax, or spinal wire, or central nervous system despair, as seen in some drug overdoses. 
  • Respiratory despair happens when the affected person’s respiratory price falls (usually <12 breaths/minute) for a chronic interval.
  • Respiratory failure happens when the affected person’s respiratory system fails to satisfy the physique’s metabolic wants. It may end up in confusion, anxiousness, or diminished LOC, and if not corrected, it will probably result in respiratory arrest.


What Does the Sample Inform You?

Even when all of the respiratory buildings are functioning, different components throughout the physique (head harm, metabolic imbalance, stroke, trauma) may cause irregular respiratory patterns, which embody:


  • Kussmaul’s respirations: quick and deep labored respiratory, typically punctuated by sighs
  • Cheyne–Stokes: a cyclical sample of respiratory characterised by progressive elevated price and depth of respirations, adopted by intervals of apnea
  • Apneustic respiratory: extended intervals of gasping inspiration, adopted by transient, ineffective expiration
  • Hyperventilation: elevated price and depth of respirations
  • Bradypnea: abnormally sluggish price of respiration
  • Apnea: the absence of respirations
  • Agonal respirations: an irregular sample that may be sluggish, shallow, deep, or gasping


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Obstructive vs. Restrictive Respiratory Ailments

When diagnosing a respiratory emergency, figuring out the kind of underlying concern the affected person is affected by will allow you to foretell which respiratory buildings are affected.


Obstructive illnesses are people who trigger issue shifting air OUT of the lungs, leading to a rise in airway resistance. They embody:


  • Bronchial asthma
  • Continual obstructive pulmonary illness
  • Cystic fibrosis: a genetic dysfunction inflicting mucus buildup within the lungs
  • Bronchiectasis: power thickening of the bronchi resulting from irritation and an infection


Restrictive illnesses are these through which the affected person has issue shifting air INTO the lungs, leading to a lack of chest or lung compliance. They embody:


  • Occupational lung illnesses
  • Asbestos
  • Mesothelioma
  • Idiopathic pulmonary fibrosis
  • Pneumonia
  • Atelectasis: the collapse of the alveoli leading to a lower or absence of fuel alternate
  • Chest-wall deformities or accidents
  • Neuromuscular illnesses that have an effect on respiratory
  • Muscular dystrophies
  • Amyotrophic lateral sclerosis
  • Myasthenia gravis


The Significance of Palpation

As you carry out your evaluation and procure an in depth historical past, remember to palpate the chest. This consists of assessing:


  • Temperature: Is the pores and skin heat and dry, or cool and clammy?
  • Crackling: A crackling or popping beneath the pores and skin can point out subcutaneous emphysema and air leakage.
  • Tracheal alignment: Is it midline or deviated, which may point out rigidity pneumothorax (though that is normally seen on a radiograph)?
  • Tour: Does the chest rise equally and symmetrically? Verify tour by putting each fingers on the chest and having the affected person take deep breaths.
  • Percussion: It is a great tool, however it requires observe to good. Regular lung fields produce resonance. Hyper-resonance can point out collapsed lung, whereas hypo-resonance can point out blood or fluid within the thoracic cavity.


A radical understanding of airway anatomy is not going to solely aid you diagnose your affected person, however will result in higher assessments, extra correct therapies, and a broader understanding of respiratory problems.


Editor’s Word: This weblog was initially revealed in June 2018. It has been re-published with further up-to-date content material.


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