Inadequate effort/rate?
Gag reflex?
-
- Nasopharyngeal airway
- Align Airway Axes
- Suction
- Utilize One/Two-Person BVM
Unsuccessful?
Successful?
Gag Reflex?
-
- Oropharyngeal airway
- Align Airway Axes
- Suction
- Utilize One/Two-Person BVM
- Consider BIAD
Unsuccessful?
Successful?
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.
-
- 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.