Airway assessment and basic airway management: SAQ

This unconscious child has airway obstruction from the tongue and soft tissues, signalled by snoring and minimal chest movement, and the low saturation confirms inadequate ventilation. The immediate task is to open the airway, suction the secretions, hold the airway open with an adjunct, and ventilate if needed, all within the first minute. ^[1]

Question 1 (10 marks)

Describe your immediate airway assessment and the basic airway management you would perform in the first minute, including the manoeuvre, the adjunct, and the positioning. ^[1]

Assess the airway with look, listen, and feel over about five seconds: look for chest and abdominal movement and colour, listen at the nose and mouth for the snoring that indicates tongue obstruction, and feel for air movement at the mouth. The snoring localises the obstruction to the tongue and soft palate falling back as pharyngeal tone is lost, and the minimal chest movement and low saturation confirm that ventilation is inadequate. ^[2]

Open the airway with a head tilt and chin lift, because there is no evidence of cervical spine injury, and suction the copious secretions under direct vision. The child is deeply unconscious with lost pharyngeal tone, so insert an oropharyngeal airway, which is the adjunct of choice when there is no gag reflex; an oropharyngeal airway in a child with a preserved gag would provoke vomiting and aspiration. ^[3]

Size the oropharyngeal airway from the corner of the mouth to the angle of the jaw or the earlobe, a facial-landmark method validated against magnetic resonance imaging. A device that is too long pushes the epiglottis down and worsens obstruction, and one too short is useless, so sizing matters. In the older child insert it with the curve following the roof of the mouth then rotate, but in an infant insert it directly under direct vision to avoid mouth trauma. ^[3]

Position matters in the young child. The large occiput flexes the neck when supine, so aim for a neutral to slightly extended position that aligns the airway, and use a small towel under the shoulders if needed to prevent over-flexion. Give high-flow oxygen by mask throughout, and be ready to ventilate with a bag-valve-mask if breathing remains inadequate once the airway is open. ^[1]