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:
https://msu.co1.qualtrics.com/jfe/fo
rm/SV_dnyv25iGncJW3eB
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