Inadequate effort/rate?

 

• Yes

 

Gag reflex?

 

• Yes

 

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

 

 Unsuccessful?

 

• • Consider nasotracheal intubation.

 

Successful?

 

• Yes

• • See Post Airway Management

• 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

• • See Post Airway Management

 

 

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.