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So now we are going to have a look at the respiratory system. We will start at the very, very top and work our way down into the lungs themselves. We start off with the nasopharynx and the oropharynx, or the nose and mouth. Problems that occur with the nose and mouth: False teeth, milk teeth, people who have bitten the tongue, blood, fluids, polyps in the nasal cavities. This type of stuff all can create problems with the airway upper. Also, we can get swelling, burns, heat. People that have been caught in house fires, in confined spaces inhale hot gases and they swell the soft tissues of the nasal cavities and the oral cavities. We can also get the same problem with anaphylaxis, where the soft tissues around the face, the mouth, and the throat swell up due to an allergic reaction.

The biggest killer with most casualties across the UK in trauma tends to be the tongue. So at the back of the throat, we then have the tongue situated. We talk about two or three different ways of opening an airway, and those airway-opening techniques are all designed to remove the tongue from the back of the throat. The classic head tilt/chin lift puts traction on the back of the throat, lifts the tongue forward, and allows air to pass. But then we also have, with spinal injuries, the jaw thrust, which allows us to do exactly the same manoeuvre without tilting the head and potentially risking severing the spinal column.

Once we go down, then we come to the trachea and the oesophagus. The oesophagus itself is where the food goes, the trachea is where the air goes. Those two pipes are very closely connected. And between the two pipes, basically, there is a thin membrane. Each part of the airway itself has a little cartilage in there, a C-shaped cartilage in the trachea, to keep the trachea open because the only way you breathe is by creating a vacuum. The chest has to expand, the diaphragm falls, creating an enlargement to the cavity of the chest. That creates the vacuum, and air then rushes in, down the trachea, into the lungs, filling the lungs with oxygen. Then passively we relax, the muscles relax, the rib cage goes back, the diaphragm lifts again back into its normal position, and the air is expelled from the chest. So the cartilages are there to keep the airway open. Because when you create a vacuum, the pipe would go flat without the cartilages. And the thin membrane between the trachea and the oesophagus are there to allow food to pass down the oesophagus when you eat something that's slightly too large, which is why you feel it go past every single cartilage in the trachea. As you swallow, you feel it pass past every one of the cartilages, which is why it is uncomfortable until it drops into your stomach.

The biggest problem with the upper airway, not only is infection and swelling, but also fluids. Stomach contents, vomit, blood. Anything at all that blocks that airway must be removed or toileted or cleaned. Because unless that airway has a clear flow, a clear passage, a clear pipe, air will not get into the lungs. If we are not careful with our airway management, stomach contents, especially when the patient lies on their back and either regurgitates or vomits, fluid comes from the stomach. That fluid is a high concentration of acid. That acid then gets re-inhaled into the lungs, and we create a condition called aspirational pneumonia.

Aspirational pneumonia will kill your patient two or three days down the line when the lung tissue gets dissolved by the acid, infection takes place, and we end up with aspirational pneumonia, which on most occasions tends to be fatal. So we need to keep the lungs clear, we need to keep the airway clear so oxygen passage isn't reduced or restricted or held back in any way shape or form. We only want clean air in that environment. And we've also got to remember that the air we breathe needs to be full of oxygen. So if we're working, or thinking about working in an environment which is low in oxygen content, we need to either supplement that with oxygen masks, with bag and masks, with airway manoeuvres, with OP or oral airways, nasal airways, and oxygen itself. We need to supplement those oxygen levels, and the only way we can do it is either clear clean air or oxygen supplementation.