Assisting Respiration and Airway Control:
When you have somebody with an airway issue, if they don’t have a tube in them, they have to be able to protect their airway, be able to exchange oxygen and release carbon dioxide, if they can’t do that, you need to control their airway. If you’re uncomfortable controlling their airway, you need to know how to bag mask ventilate patients. That does not mean hold the mask and press it down on their face and squeeze the bag. There’s a specific technique that you need to use to bag mask and ventilate someone and you should learn it since it will save someone’s life someday. If you are with an anesthesiologist or respiratory therapist, ask them to show you, and then have them watch you try to do it.
Diagnosing Acute Airway Issues in the Intubated Patient:
If the patient does have an airway, you need to make sure that the path from the outside into their lungs is clear and you need to think about it that way. So, if they’re unable to ventilate someone and they have an endotracheal tube in, the first thing you need to do is, bag ventilate them and listen to breath sounds. That will tell you whether the path to the lungs is clear. If there are no breath sounds, you need to stick a suction catherer down the endotracheal tube to ensure that path is clear. If that path is clear, you need to make sure there’s not a mechanical obstruction with a physical exam and then a stat chest x-ray. If the path from the outside to the lungs is clear, and the lungs have no pneumothorax or hemothorax or other mechanical issues, then you need to start thinking about ARDS, severe pulmonary edema, pulmonary embolism, and other intrinsic lung issues. If that’s going on and the patient can’t be ventilated adequately, you need to quickly get some experienced help to the bedside.