Difficult Airway Management
I. Airway Anatomy
B. Upper Airway Tract
1. Nose
2. Mouth and Oral Cavity
3. Jaw
4. Pharynx
a. Nasopharynx
b. Oropharynx
c. Hypopharynx
d. Laryngopharynx
i. Vallecula
a) Pyriform Sinus
5. Larynx
a. Cartilages
i. epiglottis
ii. arytenoid cartilage
a) corniculate cartilage
b) cuneiform cartilage
c) posterior arytenoids
iii. vocal cords
a) false vocal cord
b) true vocal cord
iv. thyroid cartilage
v. cricoid ring
a) arch of cricoid cartilage
b) lamina of cricoid cartilage
c) cricothyroid membrane (ligament)
b. Bone
i. Hyoid bone
a) Hyo-epiglottic ligament
C. Jugular notch
D. Lower Airway Tract
1. Trachea -- Spatial relationship to esophagus
2. Carina -- Angle of Louis
3. Bronchi
4. Lungs
a. Bronchioles
i. bronchial smooth muscle
ii. beta-two adrenergic receptors
b. Pulmonary cilia
c. Alveoli -- Surfactant
E. Support Structures
1. Chest Cage
a. Ribs
b. Muscles of respiration
i. intercostal muscles
ii. diaphragm
c. Pleura
i. parietal pleura
ii. visceral pleura
2. Phrenic nerve
3. Mediastinum
II. Airway Assessment
A. Purpose
1. Identify inadequate airway
2. Identify an unstable airway
3. Identify potentially difficult airways
B. Procedure
1. Gag Reflex
2. Airway obstruction
a. Soft tissue obstruction
b. Foreign bodies
c. Complete and incomplete
d. Upper vs. Lower
3. Work of breathing
4. Laryngospasm
5. Laryngeal edema
6. Penetrating injuries
C. Anticipating the difficult airway
1. Trauma/bleeding
2. Vomiting
3. History
4. Mouth opening
5. Mandibular length
6. Mallampati classifications
7. Obstructions
8. Neck mobility
9. Facial hair
III. Techniques of assuring a patent airway
A. Manual airway maneuvers
B. Mechanical airway devices
C. Relief of Foreign Body Airway Obstruction
1. Refer to current American Heart Association guidelines
2. Removal of foreign body airway obstructions using direct laryngoscopy
a. Purpose
b. Indications
c. Contraindications
d. Complications
e. Procedure
f. Limitation
3. Airway suctioning
a. Review and elebaorate on the upper airway suctioning material from the EMR, EMT and AEMT levels
b. Tracheobronchial Suctioning
i. purpose
ii. indications
iii. contraindications
iv. complications
v. procedure
vi. limitation
D. Blind insertion airway devices
E. Endotracheal intubation
1. Direct laryngoscopy (visualized)
a. Purpose
b. Indications
c. Contraindications
d. Complications
e. Procedure (including confirmation techniques)
f. Limitations
2. Non-visualized
a. Nasal
i. purpose
ii. indications
iii. contraindications
iv. complications
v. procedure (including confirmation techniques)
vi. limitations
b. Digital
i. purpose
ii. indications
iii. contraindications
iv. complications
v. procedure (including confirmation techniques)
vi. limitations
c. Lighted stylet
i. purpose
ii. indications
iii. contraindications
iv. complications
v. procedure (including confirmation techniques)
vi. limitations
d. Fiber optic (Shikaini Seeing Optical Stylet (SOS), Glide scope)
i. purpose
ii. indications
iii. contraindications
iv. complications
v. procedure (including confirmation techniques)
vi. limitations
F. Percutaneous cricothyrotomy
1. Purpose
2. Indications
3. Contraindications
4. Complications
5. Procedure (including confirmation techniques)
6. Limitations
I. Comprehensive ventilation assessment
A. Purpose
B. Procedure
C. Minute Volume
D. Alveolar Volume
E. Evaluating the effects of artificial ventilation
F. Pulse oximetry
1. Purpose
2. Indications
3. Contraindications
4. Complications
5. Procedure
G. Blood gas analysis
1. pH
2. PaCO2
3. PaO2
4. Bicarbonate
5. Base deficit
H. Capnography Review
1. Purpose
2. Indications
3. Contraindications
4. Complications
5. Procedure
II. Review of ventilation devices used by EMRs, EMTs and AEMTs
A. Manual devices
1. Purpose
2. Indications
3. Contraindications
4. Complications
5. Procedures
B. Mechanical devices
1. Purpose
2. Indications
3. Contraindications
4. Complications
5. Procedures
III. Assisting patient ventilations
A. Review of techniques used by EMRs, EMTs and AEMTs
1. Purpose
2. Indications
3. Contraindications
4. Complications
5. Procedures
B. Review of the physiologic differences between normal and positive pressure ventilation
C. BiPAP/CPAP
1. Purpose
2. Indications
3. Contraindications
4. Complications
5. Procedure
D. Positive End Expiratory Pressure (PEEP)
1. Purpose
a. provide positive airway pressure to prevent alveolar collapse at the end of expiration
b. refers to positive pressure situations
c. to increase lung compliance
2. Indications
a. hemodynamically stable patient receiving positive pressure ventilation
i. COPD
ii. CHF
iii. drowning
b. Patient transfer
3. Contraindications
4. Complications
a. can diminish venous return
b. can cause barotrauma
5. Procedure
Content Creator: Josh Renolds
CAPCE Course Number: 20-EMTP-F3-3204
Total CE Hours: 2
Level: Advanced
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.
