Airway Adult

 

Inadequate effort/rate?

 

  • Yes

 

Gag reflex?

 

  • Yes

 

 

 

    • Nasopharyngeal airway

 

 

 

Successful?

 

  • No
    • See RSI Protocol

 

  • Yes
    • See appropriate protocol

 

Gag Reflex?

 

  • No

 

 

 

    • Oropharyngeal airway

 

 

 

 

 

  • Yes

 

    • See appropriate protocol

 

Successful?

 

  • No

 

 

    • Consider BIAD
    • Adjust your position
    • Adjust patients position
    • Suction
    • Apply backward, upward, and to the right pressure (BURP)

 

 

 

  • Post-intubation for sedation
    • Keatamine IV/IO, see Ketamine Dosing Chart; may repeat once after 15 minutes f needed.

 

Successful?

 

  • Yes

 

    • See appropriate protocol

 

  • No

 

 

    • Insert BIAD
    • Two-person BVM or CPAP
    • to maintain O2 sats ≥ 95%

 

PEARLS:

 

  • Capnometry (color) or capnography is mandatory with all methods of intubation. Document results.
  • Continuous capnography (EtCO2) should be utilized for the monitoring of all patients with a BIAD or endotracheal tube (ETT).
  • For the purpose of this protocol a secure airway is when the patient is receiving appropriate oxygenation and ventilation.
  • 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
    • 6-10 for adolescents and adults
  • Avoid hyperventilation.
  • Maintain a EtCO2 between 35 and 45.
  • Maintain C-spine immobilization for patients with suspected spinal injury.
  • Position patient correctly prior to intubation.
  • Ramp the patient and place patient's face parallel with ceiling in a sniffing position.
  • If patient is on the stretcher (which is the ideal position for intubation), raise the stretcher and elevate the stretcher head.
  • Do not assume hyperventilation is psychogenic. Use Oxygen, not a paper bag.
  • Hyperventilation in deteriorating head trauma should only be done to maintain an EtCO2 of 30-35.
  • Signs of herniation, Cushing's Triad (hypertension, bradycardia, unequal pupils)  Adult rate 20 breaths a minute.
  • Obese adults (greater than 120 kg) desaturate to 0% in less than 3 minutes. Proceed with RSI cautiously.
  • It is important to secure the ETT well and consider c-collar to better maintain ETT placement.
  • Sellick's and or BURP maneuver should be used to assist with difficult intubations.
  • Items in Red Text are key performance measures used to evaluate protocol compliance and care.

 

 

NREMR

National Registry Emergency Medical Responder

NRP

National Registry Paramedic

NREMR

National Registry Emergency Medical Responder

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician