Open the airway by use of a chin-lift or jaw thrust without head tilt. Remember to protect the cervical spine at all times when the potential for cervical spine injury exists.
Suction is indicated in any patient whose airway is obstructed by liquid or solid material which may result in aspiration or interfere with respiration.
Use an oropharyngeal or nasopharyngeal airway device as needed to maintain a patent airway. Apply ETCO2 capnography device to bag mask ventilation if available.
Assist ventilations as needed using a bag-valve device (BVM) and 100% oxygen. (Pediatric rate - 12 - 20 / min., newborns – 40 - 60 / min.) BVM use should include the two-hand mask-seal technique whenever possible. The volume of the ventilation should be enough to provide visible chest rise.
If a patient older than 15 year of age and is in respiratory arrest with no gag reflex, insert an appropriately sized non-visualized airway, if available. Attach ETCO2capnography device if not already done. In adult cardiac arrest, performing High Quality CPR, bag mask ventilation and AED defibrillation have priority over the insertion of a non-visualized airway.
If the above measures prove to be inadequate or there is risk of aspiration or vomiting in the unconscious patient, intubate adults with an endotracheal tube or non-visualized airway. The guidelines for intubation are as follows:
Bag-valve-mask ventilation is the preferred method of oxygenating and ventilating pediatric patients. If you cannot adequately ventilate with a BVM, attempt placement of a non-visualized airway if available. If non-visualized airway fails to provide adequate oxygenation, proceed to endotracheal intubation.
Apply ETCO2 capnography device to bag mask ventilation circuit to monitor ETCO2 levels and evaluate waveform. This is highly encouraged before advanced airway placement to obtain a baseline ETCO2 value.
Endotracheal intubation is the preferred advanced airway maneuver for adults. (See Verification of Endotracheal Tube (ETT) Placement – Procedure)
The use of the non-visualized airway should be reserved for those adults in whom an endotracheal tube cannot be placed.
If unable to place an endotracheal tube after two attempts, place a non-visualized airway, if available.
If the above are unsuccessful, maintain an airway via basic skills utilizing modified jaw thrust, OP airways, BVM, etc.
Criteria for performance of cricothyrotomy are as follows:
If basic airway management, non-visualized airways, and intubation are unable to provide oxygenation and ventilation.
Surgical cricothyrotomy is to be performed on the patient > /= 8 years old.
Needle cricothyrotomy is to be performed on the patient < 8 years old
(See Procedures- Cricothyrotomy)
IF CRICOTHYROTOMY IS ATTEMPTED, A COPY OF THE PATIENT CARE REPORT MUST BE MADE AVAILABLE TO PROVIDER AGENCY SUPERVISORY PERSONNEL AND THE MEDICAL DIRECTOR WITHIN 24 HOURS OF THE RUN.