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BASIC AIRWAY ANATOMY
Basic Airway Anatomy
The upper airway is the "A" of the ABC's as such, it takes on special importance in any emergency response. As the entry point for oxygen any damage to, or blockage of, the structures in the upper airway can rapidly result in unconsciousness or death. The anatomy of the upper airway can be broken down into the nose, mouth, and throat. The medical terms for these are the nasopharynx and oropharynx/larynx.
NOSE (Nasopharynx): The nose is the primary airway used by most conscious adults to breathe. The space behind the nostrils (the nasopharynx) is filled with blood rich tissue covered in mucus, which warms and cleans incoming air.
MOUTH: The mouth is used as an alternate airway in normal adults and is especially important in emergency situations, when the nasal pathway may be blocked due to illness or trauma. The mouth is also the entrance to the digestive system and is involved in the production of speech.
THROAT (Oropharynx/Larynx): The oropharynx is the area behind the tongue at the very back of the mouth, it connects to the nasopharynx superiorly and the larynx inferiorly. The larynx and oropharynx are separated by the epiglottis.
- The Larynxis where sound is produced. Vibrations of cartilage and tissue caused by fast moving air lead to sound, which is formed into speech by the tongue and mouth.
- The Epiglottis is the mechanism that covers the opening of the trachea, the glottis when food is swallowed. It acts as a "trap door" which closes when swallowing to prevent food from entering the lower airway.
The lower airway is made up of all structures below the larynx (voice box). As in the upper airway, there are structures which transfer air; the trachea, bronchi, and bronchioles, and structures that allow oxygen and carbon dioxide to be exchanged with the blood, the alveoli.
TRACHEA: The trachea is a hollow tube which passes air to the lower airways, it differs from the airway structures above it in that it is supported by cartilage rings. The trachea sits anterior (in front of) the esophagus.
BRONCHI: The bronchi are hollow tubes which branch off of the trachea at the carina into right and left bronchi, these are known as the main stem bronchi. They then further subdivide into smaller bronchi for each lobe of the right and left lung. These structures are supported by cartilage rings.
The right mainstem bronchus points downward at a sharper angle than the left. This is why foreign bodies or aspirated material are more likely to get stuck in, or pass through, the right mainstem bronchus.
BRONCHIOLES: The bronchioles are smaller than even the bronchi and lie between the bronchi and the alveoli, they differ from the bronchi in that they do not have cartilage rings, and stay open via smooth muscle.
ALVEOLI: the alveoli are the millions of thin-walled sacs inside the lungs which are surrounded by microscopic blood vessels (capillaries). The thin walls and a significant amount of blood flow allow oxygen and carbon dioxide to be easily exchanged. The alveoli are the end of the airway.
Breathing (Ventilation vs. Respiration)
- Ventilation: The inspiration and expiration of air due to lungs filling and emptying via the movement of the diaphragm and intercostal muscles.
- Respiration: The exchange of oxygen and carbon dioxide within the alveoli of the lungs, where lung tissue interfaces with capillary blood vessels.
- Carina: The point where the trachea splits into the left and right main stem bronchi. The approximate location of the carina on the outside of the body can be seen at the Angle of Louis (manubriosternal joint) on the chest, approximately at the level of the second pair of ribs.
In summary, ventilation is the movement of air in and out of the lungs, while respiration is the exchange of air at the alveoli. Keep these definitions in mind as you may be asked to differentiate between the two on exams.
The pathway of air during ventilation is as follows:
nose → nasopharynx → glottis → trachea → main stem bronchi → bronchioles → alveoli.
The pathway of blood during respiration is as follows:
right heart -> pulmonary arteries -> alveolar capillaries -> pulmonary veins -> left heart -> body
It is important to remember that the pulmonary arteries carry deoxygenated blood and the pulmonary veins carry oxygenated blood, this is the opposite of the arteries and veins in the rest of the body and is commonly tested.
CHEST CAGE: The chest cage is made up of ribs (12 on each side) joined to the sternum anteriorly and wrapping around posteriorly to the spine. The rigidity provided by the ribs is vital to ventilation, as the diaphragm would not be able to draw air into the lungs without a solid structure to pull against.
MUSCLES OF RESPIRATION: The muscles of respiration include the muscles between the ribs (intercostals) and the diaphragm, which is the main muscle of respiration.
the intercostal muscles lie between the ribs and pull the ribs together, helping to shrink the size of the chest cavity and make the exhalation of air easier. They also help from the chest wall, which protects the organs.
The muscles of the neck and back also assist with respiration, but they help with inspiration in cases where massive airflow is needed, not during normal respiration at rest.
The diaphragm is the main ventilatory muscle, when it contracts it pulls itself downward creating negative pressure in the chest which causes air to rush into the lungs. When it relaxes, it is pulled upwards by the lungs natural recoil (springlike nature) which causes air to rush out of the lungs like a collapsing balloon.
The diaphragm is controlled by both the autonomic and voluntary nervous systems. This allows the respiratory rate to vary automatically based on the blood concentrations of CO2 and Oxygen that the brainstem senses, while also allowing you to speed up or slow your respiratory rate at will. All nerve signals to the diaphragm go through the phrenic nerve which comes from the nerve roots of the cervical spine.
The mediastinum is the center of the thoracic cavity which lies between the two lungs. it contains several structures, those involed in the respiratory system are the; heart, trachea, and great vessels (Aorta, pulnary vessels, vena cava).