Adult: Universal Airway

 

Inadequate effort/rate?

 

  • Yes

 

Gag reflex?

 

  • Yes

 

    • Nasopharyngeal airway
    • Align Airway Axes
    • Suction
    • Utilize One/Two-Person BVM

 

 Unsuccessful?

 

 

Successful?

 

  • Yes
  • No
    • See Failed Airway

 

Gag Reflex?

 

  • No

 

    • Oropharyngeal airway
    • Align Airway Axes
    • Suction
    • Utilize One/Two-Person BVM
    • Consider BIAD

 

Unsuccessful?

 

  • Consider ETT

 

Successful?

 

  • No
    • See Failed Airway

 

  • Yes

 

 

PEARLS:

 

  • BIAD is th preferred airway with patients in cardiac arrest. Deviation from this requires justification in ePCR.
  • Capnometry (color) or capnography is mandatory with all methods of advanced airway management with appropriate documentation.
  • An intubation attempt is defined as passing the laryngoscope blade or endotracheal tube past the teeth or inserted into the nasal passage.
  • Ventilatory rate:
    • 30 for neonates
    • 25 for toddlers
    • 20 for school age
    • 8-24 for adolescents and adults
  • Maintain a EtCO2 between 35 and 45 and avoid hyperventilation
  • Maintain C-spine immobilization for patients with suspected spinal injury.
  • Position patient properly for airway management.
  • If patient is on the stretcher the head of the stretcher may be elevated to align airway axes.
  • Hyperventilation in deteriorating head trauma should only be done to maintain an EtCO2 of 35-40 mmHG.
  • Obese adults (greater than 120 kg) may desaturate quickly.
  • It is important to secure the ETT well and consider c-collar to better maintain ETT placement.
  • PEEP Valves must be utilized on BVM devices for adult patients:
  • PEEP Valve Adult Patient Relative Contraindications:
    • Hypovolemia
    • Chest Trauma
    • Suspected pneumothorax
  • PEEP Valve Considerations:
    • Set PEEP to 5 cm H2O. Consider increasing PEEP to 10 cm H20, if SPO2 is less than 92% after 2 minutes of ventilation with no relative contraindications.
    • Can be uncomfortable for the awake patient
    • Monitor airway pressures using manometer and ensure correct PEEP settings.