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CHAPTER 3 Airway procedures
Jestin N. Carlson and Henry E. Wang
Introduction
Airway management is one of the most important considerations during prehospital care of critically ill or injured patients. This chapter provides an overview of the procedures and techniques that are integral to prehospital airway management.
Personal protective equipment during airway interventions
Whenever an EMS clinician performs an airway intervention, it is essential to ensure the safety of that individual and that of others in close proximity. The recent SARS‐CoV2 (COVID‐19) pandemic has highlighted the importance of personal protective equipment (PPE) during airway management. At minimum, PPE should include a facemask, face shield, and gloves. In situations where COVID‐19 or other communicable disease is a possible underlying condition, rescuers should consider using a particulate filtering mask (N95 or similar respirator), face shield, gown, and gloves (see Chapter 23) [1]. All rescuers assisting with care of the patients should wear the same level of PPE during the procedure.
Basic airway interventions
Oxygen cannulas and face masks
In spontaneously breathing patients, EMS personnel may deliver supplemental oxygen using nasal cannulas or oxygen masks. The nasal cannula provides low‐flow (2–5 L/min) oxygen in inhaled fractions (FiO2) from 0.2 to 0.4 (for convenience we will use the percentage convention: 20%–40%). Oxygen masks used in the prehospital setting include simple facemasks (6–10 L/min oxygen delivery, 40%–60% FiO2) and nonrebreather masks (10–15 L/min oxygen delivery, close to 100% FiO2).
Nasal cannulas and facemasks are designed for patients with spontaneous respiratory drive and intact protective airway reflexes. Patients with frank respiratory compromise or apnea should receive bag‐valve‐mask (BVM) ventilation support or advanced airway management.
Bag‐valve‐mask