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  1. Basic and Advanced Airways

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In this lesson, you'll learn about basic and advanced airways, including some common examples of each and things to pay attention to when using them.

Basic Airways

Basic airways are adjuncts that help direct air and oxygen around natural obstacles in the mouth, like the tongue. There are two types of basic airways:

  1. Oropharyngeal Airway (OPA) – OPAs are primarily used for patients who are usually unconscious and have no gag reflex.
  2. Nasopharyngeal Airway (NPA) – NPAs are basic airways that are inserted in patients who have a gag reflex and might be semi-conscious.

Pro Tip #1: The correct size of both OPAs and NPAs are very important in order to not cause further harm to the patient, or in some cases, even block the airway entirely. To measure for an OPA, connect or place the tip of the flange to the side of patient's mouth and the base of the curved plastic to the earlobe area.

Warning: If for any reason, a basic airway isn't effective in managing the airway for respirations, an advanced airway should be considered immediately.

Advanced Airways

The two most common types of advanced airways are endotracheal tubes and laryngeal masks.

When considering an advanced airway, it's important to recognize that these procedures require a high level of competency to avoid unnecessary injuries to soft tissues and to properly secure the airway in order to effectively oxygenate the patient. If you feel as though you haven't been adequately prepared or don't have enough experience with advanced airway techniques, you should consider getting another PALS provider who is more comfortable and experienced using these procedures.

Pro Tip #2: When considering the intubation of a child with an upper airway obstruction, you should understand that this is a high-risk procedure. Furthermore, use of a neuromuscular blockade should only be considered if the child can be sufficiently oxygenated with bag mask ventilation.

Oxygen Delivery Devices

In this section, we'll cover the most common ways to deliver oxygen therapy and the levels of oxygenation that each are capable of producing.

For Low Flow Oxygen

  • Nasal cannula
  • Simple oxygen mask with no rebreather reservoir

For High Flow Oxygen

  • Non-rebreather mask with a reservoir
  • High flow nasal cannula

There are several factors that will affect the level of true oxygen therapy delivered to the patient, regardless of the delivery mechanisms, including:

  • The oxygen flow into the device itself
  • The ability of the child to inspire the oxygenated air
  • How well the device adheres to the child's face

Oxygen percentages of O2 delivered will be different for each device.

Nasal Cannula

When using a nasal cannula, expect a concentration of between 22-60 percent depending on the flow and the ability of the child to inspire the gas.

There are both high flow nasal cannulas and low flow nasal cannulas. A low flow nasal cannula will be close to the low end of that scale above, or 22 percent. While a high flow cannula will be closer to the high end, or 60 percent.

Pro Tip #3: A high flow cannula can be adjusted from 4 liters per minute to 40 liters per minute. It can also be titrated to produce additional inspiratory and expiratory pressure which may help to improve the patient's workload while trying to breathe.

Simple Oxygen Mask

When delivering low flow oxygen, you can expect delivery rates between 35-60 percent. And the oxygen flow rate should be set to between 6 liters per minute and 10 liters per minute.

A simple oxygen mask cannot deliver a high oxygen concentration greater than 60 percent. For greater oxygen delivery, you'll need to use other delivery mechanisms, like high flow oxygen systems, which are much more reliable for delivering higher concentrations.

Non-Rebreathing Mask

A non-rebreathing mask is capable of delivering up to 95 percent oxygen at a flow rate between 10-15 liters per minute.

However, this depends on how well the mask seals to the patient's face. It's also important to remember to adjust the oxygen flow rate to keep the reservoir bag inflated, which will affect the oxygen percentage delivered to the patient.

Treatments for Upper Airway Obstructions

One of the most common methods for treating an upper airway obstruction, like asthma, is with a nebulizer.

A nebulizer can be used to humidify the air in order to help thin secretions or deliver medications, such as epinephrine or albuterol. When using a nebulizer, it should be used in conjunction with 5-6 liters per minute of low flow oxygen in order to appropriately nebulize the solution.

A nebulizer can be used with a face mask or using a tea pipe style delivery mechanism. The delivery system you choose should be dependent on the patient's age and level of consciousness.