The How & Why of EMS Airway ManagementAndrea Abbas MS NRP FTO

EMS Programs Manager

Disclaimer

This one hour webinar is in no way a comprehensive airway course. The

content selected is presented within a one hour time frame and does not

serve as a comprehensive review of airway techniques.

The content delivered during this webinar does not serve as comprehensive

airway techniques course for EMS providers. The center will not be held liable

for provider clinical knowledge or decision making based on the general

information presented in this presentation. This presentation is intended for

discussion and review of techniques only.

Airway Anatomy & Physiology

Ventilation vs. Respiration: Respiratory

Physiology

Pulmonary ventilation: the mechanical process of bringing oxygen into the lungs and removing carbon dioxide.

External respiration: is the diffusion of oxygen and carbon dioxide between the inspired air and pulmonary capillaries.

Internal respiration: the diffusion of oxygen and carbon dioxide between capillary red blood cells and tissue cells.

Describe the phrenic nerve:

Describe surfactant:

Pulmonary

Respiration:

Gas Exchange

How is gas exchange

effected in disease

states such as:

CHF

COPD

Asthma

Pneumonia

Abnormal Conditions That Can Affect Blood Oxygenation

1. Depressed respiratory drive

2. Paralysis of respiratory muscles

3. Increased resistance in the respiratory airways

4. Decreased compliance of the lungs

5. Chest wall abnormalities

6. Decreased surface area for gas exchange

7. Increased thickness of the respiratory membrane

8. Ventilation/Perfusion mismatch

9. Reduced capacity of the blood to transport oxygen

Respiratory Control Centers

The Basics of Patient Assessment

Scene safety

Airway Control

Breathing

Circulation

Disability

Exposure

Read the patient

Read the scene

React

Reevaluate

Revise management plan

Review performance

Scenario

You respond lights and sirens to a 67 yo male c/o of difficulty breathing. You find John laying on his couch confused. Vital signs are: BP 168/77, HR 105 and regular, RR 24 and shallow, SpO2 66% on room air. John has a hx of COPD and smokes a pack a day. He has never been to a doctor. John has a productive cough that he describes as chronic. Lung sounds: wheezes/rhonchi.

What do you suspect is happening with John?

How would you manage John?

Advanced airways are not always needed.

Outcomes using BLS airway management often surpass

ALS airway management

You are called lights and sirens to the McDonalds

parking lot for an overdose. You arrive on scene to a

29 yo female unresponsive in the front passenger seat

of a vehicle. The driver of the vehicle states she left

and went to the bathroom and when she returned he

went inside to get food. He returned and found her

unresponsive. She is breathing at 4-6 breaths per

minute and she’s cyanotic. Her lips are blue. Her

pupils are pin point.

How would you manage her airway?

What do you think is happening with this patient?

Scenario

Opening the airway:

Head –tilt chin lift

Jaw-thrust

Basic Airway

Management, Adult

Open the airway

Ventilate with a BVM at a rate of:

If there is no gag-reflex insert an OPA. Select the proper size by measuring:

Is suction needed?

Suction should not be applied for longer than:

What about nasopharyngeal airways?

Advanced Airway Management

Subglottic airway techniques

ET tube intubation

Nasotracheal intubation

Supraglottic airway techniques

LMA

Combitube

King LT-D

i-gel

Indications for Tracheal Intubation

The provider is unable to ventilate an unconscious patient with conventional methods (BVM).

The patient cannot protect his/her own airway.

Prolonged artificial ventilation is needed.

ET Tube Sizing

Laryngoscope

Blades

Mac Blades: designed to be

inserted into the vallecula.

Displaces the tongue to the left.

Miller Blades: Applied directly to

the epiglottis to expose the vocal

cords. Usually recommended for

infant intubation.

Providers should try both and

develop a preference.

Intubation

Oxygenate

Position your patient in the sniffing position unless spinal injury is suspected

Create space and position the patient to best visualize the airway

Prepare your equipment. Plan A and Plan B

Check your equipment

Inspect the oral cavity. Suction if needed.

Advance the ET-tube.

Confirm placement and secure the tube.

Using a Bougie with Intubation

Scenario

You are called lights and sirens to a 6 y.o. patient that was found

unresponsive in a nearby lake. Prior to arrival, the first response paramedic

intubated the patient. Care was handed off to you and your partner. The

paramedic confirmed his tube placement prior to hand-off. You and your

partner are in the back and fire drives you to the hospital. Enroute, end tidal

CO2 is utilized and is registering zero. You note emesis inside of the ET tube

and begin suctioning. You re-check tube placement and listen lung sounds.

Tube placement is the correct depth and lung sounds are present. Your

capnography continues to register as zero.

What do you do?

Current Research: Airway Management

in Cardiac Arrest Patients, JAMA

EMSCC Briefing Nov 2019.pdf

Bibliography

1. AHA 2019 Focused Update, Journal of the American Medical Association

2019. Laryngeal vs. Endotracheal Intubation in Cardiac Arrest Patients.

2. 4 Tips for Airway Management Mastery, EMS1 T. Nowak 2019.

3. Sanders Paramedic Textbook, American Academy of Orthopedic Surgeons.

M. Sanders and K. McKenna 5th edition.

4. Using a Bougie for Intubation. EMCrit Podcast 6/3/2010.

You Must Complete the CE Quiz and Evaluation Within One Week of the EMS Webinar to Receive CE credit CE quiz and evaluation link:

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