ADVANCED AIRWAY MANAGEMENT
Adequate airway management is a primary determinant in the outcome of many traumatic and
medical emergencies. Along with the control of significant bleeding and establishment of
circulation, airway control is the first concern in the management of the victim of a
medical emergency.In many cases, the basic Prehospital care techniques of suctioning, oral
airway, and oxygen administration
by mask or cannula are the only necessary adjunctive techniques for airway management.
The primary need for total ventilatory control, using an esophageal airway or endotracheal
tube, in prehospital patient management is the treatment of complete ventilatory failure
in the patient in deep coma, respiratory or cardiorespiratory arrest. Other situations may
also require the use of these techniques.
When there is any doubt, contact Medical Control.
Nasal Endotracheal Intubation
Indications
ad slightly, depress trachea, lift jaw up, or place patient in sniff position (if C-spine
is not a concern); be gentle.
I. Advance while listening for maximal breath sounds; then advance the tube quickly during
patient inspiration. With spontaneous respirations you should hear breath sounds in tube;
inflate cuff; then check breath sounds bilaterally.
J. If you have problems, observe external area around "cords" for tube to help
locate distal end position of tube.
1. Once tube is in trachea, advance to approximately 23 or 24 cm on adult female or 24 or
25 cm on adult male; inflate cuff.
2. Check for bilateral breath sounds. If present, continue ventilation. If unilateral
respirations are heard only; deflate cuff, reposition, reinflate cuff and recheck. If no
breath sounds are heard; deflate the cuff and completely remove; hyperventilate with 100%
oxygen, and repeat attempt. After a maximum of three (3) intubation attempts, airway
management shall be restricted to the use of basic life support airway techniques
utilizing the bag-valve-mask and BLS adjuncts.
Cricothyroidtomy (Needle)
Indications
Field diagnosis indicates an airway obstruction not relieved by manual techniques,
suctioning, or direct laryngoscopy;
A. Upper airway obstruction.
1. Secondary to trauma.
2. Foreign bodies.
3. Infection.
4. Edema.
B. Failure of all other advanced airway procedures with continued respiratory compromise.
Technique
A. After obtaining Medical Control approval, locate thyroid membrane.
B. Prep anterior neck with Betadine.
C. Attach 12-14 gauge catheter over needle to 10 cc syringe.
D. Advance the apparatus at an angle of 30 to 40° (needle tip slightly caudal) until a
"pop" is heard/felt and air is aspirated in syringe.
E. Advance catheter off the needle while withdrawing the needle. Apply 100% oxygen. If no
spontaneous respirations are noted, consider attachment of 3.0 pediatric ET bag-valve-mask
adapter to the catheter hub and ventilate the patient with positive pressure breathing
device or bag-valve-mask .
Date Revised 4/99 Medical Control Approved:5/99 EMS Division
Approved: 11/99 |
