Establishment of Airway Patency

The first concern in the management of a patient in critical condition is adequacy of the airway. Partial or complete airway obstruction must be overcome quickly. In some cases, such as an airway obstructed by a tongue, simple maneuvers will suffice. In other cases, particularly those in which myriads of obstructing agents are combining to block the airway, the task will be formidable. The tongue, dentures, swollen or distorted tissues, blood, and vomitus are common obstructing agents that make intubation difficult. Clearing obstructing agents may be made more difficult by muscular activity due to reflex stimulation or patient efforts to improve oxygenation. Moreover, the neck motion required for suction and intubation must be carefully managed in the face of potential cervical spine instability.

The wide availability of pulse oximetry monitors has greatly improved our ability to monitor oxygenation for patients at risk of airway or ventilatory compromise. Clinically subtle deterioration is much more quickly and easily recognized using the monitors. They have become standard equipment in emergency departments, intensive care units, and operating rooms to allow early recognition of patient deterioration.

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