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Lesson

Soiled Airway and Aspiration

11 min Airway & Breathing Skip to quiz

Objective: Clear vomit or blood with position and suction before you look. Bag, or place a supraglottic airway. Do not pass a tube through vomit.

Why this matters

Textbooks show clean vocal cords. On scene you often find vomit or blood. Oxygen comes first. A bag or a supraglottic airway can be the right tool. A long look through a pool of vomit is how the tube goes into the esophagus and the sat falls. Position the head, empty the mouth, then decide.

Verbalize
  • Suction is on and tested. A rigid Yankauer tip clogs, so I have a plan for thick vomit.
  • I turn the head or roll them if I can. Gravity moves fluid out of the airway.
  • If I cannot see the cords, I do not push a tube. I suction, I bag, or I place a supraglottic airway.
  • I put a waveform on whatever I place. I do not call a tube good because I saw it pass through blood or vomit.

Clinical sequence

  1. Open the airway. Turn the head if you can. Suction the mouth until you see anatomy, or until the sat forces you to bag. Use wide-bore suction. Do not look through vomit and guess.
  2. Use a two-person bag with an adjunct. A two-handed jaw-thrust seal beats a one-handed E-C clamp. If the mask fills with fluid, suction again. Do not just squeeze harder. Line the ear up with the sternal notch. A soiled airway plus a flexed neck is two problems.
  3. If you need a look with a blade, suction first, take a short look, then give oxygen again. Attempt limits still apply. Suction-assisted laryngoscopy and airway decontamination is a training skill if your service teaches it. It is not a reason to skip oxygen.
  4. A supraglottic airway you can bag through, in a dirty airway, is a successful airway. Confirm it with a waveform. End-tidal carbon dioxide is that trace on the monitor. Check it again if they vomit again, because tubes and supraglottic airways move.

Teaching points

  • The goal is oxygen, not a tube passed through vomit. An esophageal tube is the complication you cannot afford.
  • If fluid keeps covering the view, stop the look and place a supraglottic airway you can bag.

Common errors

  • Taking three looks through vomit with no suction.
  • Using a clogged Yankauer and having no backup suction.
  • Calling the tube good because you saw it pass through blood or vomit.

Practice

One-minute check

Partner: unresponsive overdose, mouth full of vomit, sat 70%. Say what you do in the first 20 seconds. Then: you placed an SGA and the sat is rising. What confirms the airway?

Related: Suction That Actually Works, Failed Oxygenation: DOPE-S, Supraglottic Airways in the Field.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. The first move in a vomit-filled airway is:
2. In a dirty airway, what comes first?
3. A tube placed through a pool of vomit is most at risk of:
4. After any airway in a soiled patient, confirmation is:
← Pediatric Work of Breathing Unrecognized Esophageal Intubation →