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

OR

 

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.