Airway Management (Adult)

EMT STANDING ORDERS: -

• Routine Patient Care.
• Establish airway patency.
  • Open and maintain the airway.
  • Suctioning as needed.
  • Clear foreign body obstructions.
  • Consider inserting an oropharyngeal or nasopharyngeal airway adjunct.
  • Consider inserting a Supraglotic Airway (LMA)
• Administer oxygen as appropriate with a target of achieving 94 - 98% saturation.
• Consider inserting an oropharyngeal or nasopharyngeal airway adjunct.
• If patient has a tracheostomy tube, see Tracheostomy Care Procedure - Adult & Pediatric (28 Skills).
• For apnea or hypoventilation and decreased level of consciousness with possible narcotic overdose, administer naloxone. See Poisoning/Substance Abuse/ Overdose Protocol - Adult (20 medical).
• Assist ventilations with a bag-valve-mask device and supplemental oxygen as needed.

ADVANCED EMT STANDING ORDERS:

• In cardiac arrest, consider insertion of a supraglottic airway. See Supraglottic Airway Procedure - Adult & Pediatric (6 Skills).
• For adults in severe respiratory distress secondary to pulmonary edema, COPD, asthma, pneumonia, near drowning or undifferentiated respiratory distress.

PARAMEDIC STANDING ORDERS:

• Consider high-flow nasal canula if appropriate administration system is available.
• For impending respiratory failure with intact gag reflex or trismus: consider nasotracheal intubation. See Nasotracheal Intubation Procedure (12 Skills).
• For apnea/respiratory failure or impending respiratory failure with impaired or absent gag reflex: consider supraglottic airway device or orotracheal intubation. See Orotracheal Intubation Procedure (6 Skills), Supraglottic Airway Procedure - Adult & Pediatric (12 Skills).
• For adults with severe airway compromise where respiratory arrest is imminent and other methods of airway management are ineffective: consider Rapid Sequence Intubation.
  • Note: This procedure is only to be used by paramedics who are trained and credentialed to perform RSI in accordance with Medical Direction policy.