Post Airway Management

 

ETT, Nasal intubation, or Supraglottic Airway device

 

  • Verify tube placement through ausculation, continuous capnography and pulse oximetry
  • After 3 ventilations, ETCO2 should be > 10 or comparable to pre-intubation values

 

  • No
    • Direct Look to confirm ETT placment

 

Dislodged?

  • Yes
    • Reposition ETT or remove and ventilate with BVM
  • NO
    • Secure tube
    • Remove nasal cannula if using apneic oxygenation

 

Systolic BP < 90 mm/Hg

 

  • Yes

OR

 

PEARLS:

  • Etiology of hypotension post intubation: Tension pneumothorax, Hyperventilation, Hypovolemia, or shock.
  • Ketamine should be used for sedation in the presence of hypotension.
  • Waveform capnography and pulse oximetry must be utilized for a minimum of 5 minutes after tube placement prior to the administration of Vecuronium (Norcuron) and is required for intubation verification and ongoing patient monitoring.
  • Bradycardia after tube placement is a strong predictor or a misplaced endotracheal tube (ETT).
  • It is required that the airway be monitored continuously through waveform capnography and pulse oximetry.
  • An Airway evaluation form must be completed on every patient who receives advanced airway management.
  • Confirm airway placement by ED staff prior to moving the patient from EMS stretcher.