Airway Flashcards
(16 cards)
Once paralytics are administered,
the designated Lieutenant or Flight Crew shall be responsible for ensuring an airway is obtained & accompany the patient to the emergency department (excluding air rescue transport).
Sedation for facilitation of an advanced airway in a pediatric patient
▪ Etomidate: 0.3 mg/kg Max 30 mg OR
▪ Ketamine: 1 mg/kg
All patients shall receive _____ prior to and during advanced airway procedures
high flow O2 Via Nasal Cannula
Indications for Paralytic Medications
Status Epilepticus
Multi-System Trauma
Head Injury / GCS 8 or Less
Trismus (Lock-Jaw) or clenched teeth
Burn injuries to the upper airway
Flight Crew, SWAT Medic, or EMS Captains Discretion
Adult RSI Induction for airway control
- Induction, Paralytic, Post Intubation Sedation/ Paralysis
- Induction -
▪ ETOMIDATE: 30mg or 0.3mg/kg IV/IO Over 30-60 seconds. May repeat 1x prn. OR
▪ KETAMINE: 200mg IV/IO. May repeat 1x prn. Max Single dose 200mg. - Paralytic -
- Rocuronium 50-100 mg IV/IO (1.0 mg/Kg)
- Post Intubation Sedation/Paralysis -
▪ KETAMINE: 200mg IV/IO as needed to maintain sedation. May repeat 1x prn. Max single dose 200mg.
▪ Rocuronium: 50-100 mg IV/IO (1.0 mg/Kg) repeat1x as needed
▪ Failed Airway: exhaust all options with BVM and supraglottic airway, if unable to ventilate then perform SURGICAL AIRWAY
Pediatric RSI Induction for airway control
- Induction, Paralytic, Post Intubation Sedation Paralysis
- Induction -
▪ ETOMIDATE: 0.3mg/kg IV/IO
▪ OR
▪ KETAMINE 1mg/kg IV/IO/IM. - Paralytic -
▪ ROCURONIUM 1 MG/KG IV/IO.
▪ DO NOT GIVE ROCURONIUM WITHOUT INDUCTION AGENT - Post Intubation Sedation and Paralysis
▪ Once successfully intubated
▪ SEDATION KETAMINE: 1mg/kg IV/IO
▪ AND (IF NECESSARY)
▪ PARALYSIS: Rocuronium 1 MG/KG IV/IO
Failed Endotracheal intubation
If definitive airway cannot be secured with two ETT intubation attempts, a Surgical Airway should be inserted. Flight Crew may perform an
additional attempt if necessary.
When should you perform a surgical airway?
If an airway cannot be secured by any other means, and the patient can not be effectively oxygenated or ventilated, a cricothyrotomy should be performed on adult patients (or needle cricothyrotomy for pediatrics).
Needle Cricothyrotomy Procedure
▪ Patient should be placed supine (ensure cervical spine immobilization if trauma is
suspected).
▪ With non-dominant hand, stabilize the trachea between the thumb and middle
finger and locate the cricothyroid membrane with the index finger.
▪ Find the landmark by palpating the patient’s neck from the top
o The first prominence felt is the thyroid cartilage; the second prominence is the
cricoid cartilage.
o The space between the two, characterized by a small depression, is the
cricothyroid membrane.
▪ Cleanse the site using antiseptic swab.
▪ Attach a 10mL syringe to the needle of a 14 g catheter over needle set. Flash
chamber cap must be removed.
▪ Insert needle through the cricothyroid membrane at a 45 – 60 degree angle
caudally while applying negative pressure to the syringe. Aspiration of air into the
syringe indicates entry into the trachea.
▪ Advance catheter over the needle until the hub makes contact with skin.
▪ Attach BVM to luer-lock adaptor to 14g catheter.
▪ Insert OPA or NPA (unless contraindicated) to facilitate passive exhalation.
▪ Ventilate patient using the appropriate BVM.
▪ Although it may be difficult to hear, auscultate lung sounds.
▪ Constantly maintain catheter placement with your hand only.
▪ Ventilate at a 1:3 IE (inspiration to expiration) ratio, a breath delivered at 1 second
with a 3 second exhalation period.
Surgical Cricothyrotomy Contraindications
Children 10 years old and under
Surgical Cricothyrotomy Procedure
▪ Patient should be placed supine (ensure cervical spine immobilization if trauma is
suspected).
▪ With non-dominant hand, stabilize the trachea between the thumb and middle
finger and locate the cricothyroid membrane with the index finger.
▪ Find the landmark by palpating the patient’s neck from the top.
▪ The first prominence felt is the thyroid cartilage; the second prominence is the
cricoid cartilage. The space between the two, characterized by a small depression,
is the cricothyroid membrane.
▪ Cleanse the site using antiseptic swab.
▪ Make a 2 cm horizontal incision with a scalpel through the membrane.
o If needed, a 2 - 4 cm vertical incision may be utilized prior to the horizontal
incision to aid in exposing anatomical landmarks in patients where palpation
is difficult.
▪ Insert hemostats into incision and rotate 90 degrees to allow placement of
tracheal tube introducer or Bougie.
o Optional, not required: A tracheal hook may be utilized to facilitate tracheal
tube placement. Remove rubber cap from hook, insert hook horizontally into
incision until the back curved end makes contact with the posterior of the
trachea, rotate hook 90° and pull caudally at a slightly upward angle to
capture the distal end of the incision and dilate opening.
o To remove hook after tube placement, push hook downward to release from
trachea, rotate hook 90° horizontally and gently withdraw from trachea, using
care as to not puncture the tracheal tube cuff.
▪ Confirm tube placement by auscultating lung sounds, observing tube condensation and attaching waveform capnography
▪ Once tube placement is confirmed, secure the tube with included tie-outs by tying
around the patient’s neck.
Equipment needed for Needle Cricothyrotomy
- Iodine Prep pads
- 14g Needle Cric
- 10cc syringe
- Luer-lock BVM adapter
- BVM
- Stethoscope
- OPA (properly sized)
- NPA (properly sized)
Equipment Needed for a surgical cricothyrotomy
- Iodine prep pads
- Scalpel
*Kelly Clamp - Bougie
- Tracheal tube, or cut down ET tube
- 10cc syringe
- Lubrication
- ET ETCO2
- Stethoscope
Indication for Endotracheal Intubation
Any patient in need of intubation who cannot protect and maintain their own airway
Cautions for Endotracheal Intubation
▪ Do not use the teeth as a fulcrum
▪ Remove loose dentures
Endotracheal Intubation Prodedure
▪ Use universal precautions
▪ Select the appropriate size ET tube
▪ Insert appropriate size stylet
▪ Inflate and test cuff
▪ Deflate the cuff (leave syringe attached)
▪ Check laryngoscope light
▪ Pre-oxygenate the patient
▪ Place the patient in the sniffing position if not contraindicated
▪ Hold laryngoscope with the left hand
▪ Insert the laryngoscope blade in the mouth, sweeping the tongue to the left
▪ Visualize the vocal cords
▪ Insert the ET tube
▪ Maintain visualization as tube is passed
▪ Remove the laryngoscope blade
▪ Inflate the cuff with air and remove the syringe
▪ Ventilate the patient observing chest rise, auscultate epigastric and lung sounds
▪ Note the depth of the tube
▪ Confirm proper tube placement with waveform capnography, absence of bowel
sounds, auscultation of lung sounds and tube condensation.
▪ Secure the tube with a restraint device
