Anatomy And Pathophysiology

Prior to airway management procedures, when there is sufficient time, the physician should:

1. Inspect the patient's mouth for size of teeth and size and mobility of the jaw.

2. Open the patient's mouth and observe the palate, tongue, and oropharynx.

3. Flex the stable neck (in the absence of trauma), and assess mobility, and place in the sniffing position.

4. Examine the size and alignment of the neck.

5. Inspect the nasal openings for patency.

6. Ask the patient's history, if possible.

7. Listen for abnormal airway sounds like stridor, hoarseness, or gurgling.

8. Be sure to have suction available at all times, especially during any procedures.

The anatomic airway (Fig 14:1) begins at the oral/nasal cavities and continues posteriorly to the tongue/turbinates; the tonsils/adenoids; past the palate; through the oropharynx; across the epiglottis, which protects the glottis (the narrowest portion of the airway); past the false and true vocal cords; and into the larynx. Surrounding the larynx is the thyroid cartilage, cricoid cartilage, and thyroid gland. The upper airway ends here; the lower airway then continues to the trachea and into the lungs. Potential obstruction may develop anywhere along this route. In infants and small children, the anatomy is somewhat different than in the adult. The tongue is relatively larger in relation to the mandible. The glottis is higher and more anterior and the vocal cords are angled more anteriorly and inferiorly. The epiglottis is large and floppy and may lie against the posterior wall of the pharynx.

FIG. 14-1. The anatomic airway.
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