Milwaukee County Office of Emergency Management-EMS Division (OEM-EMS) Respiratory - Airway AIRWAY MANAGEMENT Practice Guideline Patient Care Goals 1. Recognize and alleviate respiratory distress Universal Care 2. Provide effective oxygenation and ventilation through support interventions Patient Presentation: Inclusion Criteria Signs of severe respiratory distress or failure. Supplemental oxygen if Patients with hypoxemia or hypoventilation. hypoxic (<94%) on room Exclusion Criteria air Patients who improve w/supplemental O2-other interventions Protected patent airway Treatment Moderate/Severe Distress CPAP CPAP for moderate to severe respiratory distress. Suction NPA/OPA for anyone with impaired protective reflexes. Airway NPA/OPA BVM for hypoventilation or respiratory failure; insert 2 NPA’s & OPA when using BVM to assist effective ventilations. Advanced Airway Management: OEM-Approved Supraglottic Airway (SGA) Preferred airway for uncomplicated, sudden cardiac arrest, BVM w/ EtCO2 especially when intubation is anticipated to be difficult due to patient access or poor anatomy. Pre & Post waveform continuous capnography is required. If SGA is inserted without immediate access to waveform capnography, a colorimetric CO2 detector is required after Consi de r Foreign Body KING Airway insertion until capnography becomes available. removal Able to ventilate/o xygenate .No. Ai rway .No. placement Video Assisted Endotracheal Intubation of .No. w/BVM Obstruction? successful Preferred airway when sudden cardiac arrest is suspected to adv anced result from bronchospasm (asthma), poor lung compliance ai rway (pulmonary edema, drowning) or angioedema. Pre & Post waveform continuous capnography is required. Yes Yes Yes If pre-insertion waveform capnography is not working for any reason-you should not attempt video assisted ET intubation Video assisted endotracheal intubation should not interrupt CPR more than 10 seconds . Pediatric Ag e ≤12 yrs Video assisted endotracheal intubation should not be Supraglottic Airway Foreign Needle attempted more than twice before moving to King airway. D O - - - Body Cricothyroidotomy Troubleshooting: Adult Ai rway - - - - - - On initial insertion of VL ET tube during early resuscitation of a P Supraglottic Airway or Obst Age >12 yrs viable SCA (VF, VT, PEA), tube is incorrectly positioned— E Video Assisted Guideline Surgical remove immediately and resume airway management. Endotracheal Intubation Cricothyroidotomy *NOTE: A gradual decline in capnography suggests a patient is not responding to resuscitation (or possible provider fatigue). A sudden loss of capnography suggests airway dislodgement or ventilation failure (DOPE-dislodgement, obstructed, pneumothorax, equipment). Remove advanced airway Capnography immediately & resume airway management. Gastric Suctioning Patient Safety Considerations Optimize ventilate rate and volume Capnography is a critical safety tool Sedation following airway placement PRN Consider advanced airway in unresponsive trauma pts with compromised airway protection and/or GCS ≤8 based on pt indicators (able to open pts mouth, absent gag reflex/ tolerates NPA OPA or suction, provider judgment) Able to Quality Improvement: ventilate/oxygenate Key Docum entation Elem ent s .No. and EtCO2 waveform capnography trends EtCO2 >0 EtCO2 colorimetric confirmation until capno available Clinical indications if ET is used Performance Measures 1. VL for all endotracheal intubation attempts. Yes 2. EtCO2 w/in 3 minutes of capable unit arrival (includes BVM) 3. Pre/Post intubation capnography 4. Ventilation rate Continue ventilation/oxygenation Initiated: 07/01/2011 Approved: Benjamin Weston, MD, MPH Medical Director Reviewed/Revised: 04/15/2021 Approved: Dan Pojar, BSEMS, FP-C, NRP EMS Division Director Pg 1 of 1 Revision 5 WI DHS EMS Approval: 06/15/2020 .