The upper airway can obstruct due to soft tissues, blood, secretions and infections. In patients who are sedated, anaesthetised or unconscious, the commonest cause is due to loss of airway muscle tone. The usual site of obstruction is the soft palate followed by the epiglottis and occasionally the tongue. To relieve the obstruction, a head tilt, chin lift jaw thrust and open mouth manoeuvre should be performed. This will tense the muscles in the floor of the mouth causing the hyoid and larynx to be lifted away from the posterior pharyngeal wall. Oral and nasal airways are useful adjuncts to improve airway patency. In patients who are unconscious or adequately anaesthetised, the laryngeal mask or Combitube® could be used especially in the difficult airway situation. As there is a significant decline in performance with time, it is important to maintain airway skills through regular practice and evaluation.
Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians and intensivists.
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