Airway Management Basics

Airway Management Basics 
for OTAT & Paramedical Interns

 (A Practical Guide for OTAT, Paramedical & Allied Health Students)

1. Introduction:

Why Airway Management Matters Most? 

Airway management is the first and most critical skill every intern must understand while working in the Operation Theatre (OT), ICU, or Emergency Room (ER). If the airway is not maintained, oxygen cannot reach the lungs, and nothing else matters.

Many interns make common mistakes like poor mask seal, wrong airway size, or delayed airway support. Learning the basics of airway management early improves patient safety, builds confidence, and prepares interns for real-world clinical situations.

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2. What Is Airway Management?

Airway management refers to maintaining a clear, open airway to ensure proper oxygenation and ventilation.

It is commonly required in:

• Operation Theatres

• Intensive Care Units (ICU)

• Emergency Rooms

• Post-anaesthesia recovery areas

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3. Normal Airway Anatomy

Understanding basic anatomy helps interns choose the right airway technique.

Key structures:

• Oral cavity

• Pharynx

• Larynx

• Trachea

• Epiglottis (prevents aspiration)

• Vocal cords (guide tube placement)

4. When Does a Patient Need Airway Support?

Interns should immediately suspect airway compromise if any of the following are present:

• GCS < 8

• Snoring or gurgling sounds

• Stridor

• Apnoea or gasping

• Low SpO₂

• Facial trauma

• Post-anaesthesia recovery

🧠 Easy Memory Tip: SAG-FAR

Stridor
Apnoea
Gurgling
Facial trauma
Airway obstruction
Reduced GCS

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5. Basic Airway Maneuvers

1️⃣ Head Tilt–Chin Lift

Use when: No suspected cervical spine injury
Avoid when: Trauma or suspected neck injury

2️⃣ Jaw Thrust Maneuver

Indicated in: Trauma patients
Helps open the airway without moving the neck.

3️⃣ Suctioning the Airway

• Use the correct catheter size

• Duration: < 15 seconds

• Pre-oxygenate and re-oxygenate the patient

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6. Airway Adjuncts 

A. OPA – Oropharyngeal Airway

• Prevents tongue obstruction

• Contraindicated in conscious patients

• Choose a size from the corner of the mouth to the angle of the jaw

B. NPA – Nasopharyngeal Airway

• Preferred in semi-conscious patients

• Lubrication required

• Contraindicated in basilar skull fracture

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7. Bag-Valve-Mask (BVM) Ventilation

BVM is a life-saving skill for interns.

Key points:

• Use the E-C clamp technique for a proper mask seal

•  The Two-person technique is safer and more effective

Ventilation Rate:

• Adults: 10–12/min

• Children: 12–20/min

• Infants: 20–30/min

Common mistakes:
Over-ventilation, poor mask seal, and wrong hand position.

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8. Endotracheal Tube (ETT) — Basics Only

(For understanding, not for performing intubation)

• ETT secures a definitive airway

• Common sizes:

  • Adult male: 8.0–8.5

  • Adult female: 7.0–7.5

• Check placement by:

  • Chest rise

  • SpO₂

  • ETCO₂ (if available)

DO NOT attempt intubation without supervision.

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9. LMA (Laryngeal Mask Airway)

LMA is a supraglottic airway device used when intubation is not ideal.

Advantages:

• Easy insertion

• Useful in short procedures

Limitations:

• Not ideal for high aspiration risk

• Limited airway protection

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10. Oxygen Delivery Devices (Beginner Guide)

Device	Flow Rate	FiO₂
Nasal Cannula	1–6 L/min	24–44%
Simple Face Mask	5–10 L/min	40–60%
Non-Rebreather Mask	10–15 L/min	Up to 95%
Venturi Mask	Fixed	Precise FiO₂

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11. Airway Assessment Made Easy (LEMON Method)

L – Look (face, teeth, beard)
E – Evaluate (3-3-2 rule)
M – Mallampati score
O – Obstruction
N – Neck mobility

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12. Common Mistakes Interns Make

• Choosing the wrong airway size

• Poor BVM seal

• Over-ventilation

• Forgetting suction

• Not reassessing airway patency

💡 Download the printable Airway Cheat Sheet — coming soon on tnahs.in

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13. Quick Revision PDF (Coming Soon)

A 1-page airway summary PDF will be available for download to help with:

• Exam revision

• OT postings

• Emergency duty preparation

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14. Conclusion

Airway management is a core life-saving skill that every intern must master. Understanding the basics, practicing under supervision, and avoiding common mistakes can significantly improve patient outcomes. Strong airway fundamentals build confidence and prepare you for real clinical challenges.

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FAQs

1. What is airway management?
It is the process of keeping the airway open to ensure proper oxygenation and ventilation.

2. Why is airway management important for interns?
Because early airway support prevents hypoxia and can save lives in emergencies.

3. What is the first step in airway management?
Assess airway patency and perform basic airway maneuvers if needed.

4. When should jaw thrust be used?
In trauma patients or when cervical spine injury is suspected.

5. What airway adjuncts are commonly used by interns?
OPA and NPA are the most commonly used airway adjuncts.

6. What is the correct BVM ventilation rate?
Adults: 10–12/min, Children: 12–20/min, Infants: 20–30/min.

7. What is the E-C clamp technique?

A hand technique used to achieve a proper mask seal during BVM ventilation.

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