TL;DR
Advanced Airway Management: Paramedic-level: ETT intubation, supraglottic airways, RSI, and cricothyrotomy.
Advanced Airway Management
Definition
Paramedic-level: ETT intubation, supraglottic airways, RSI, and cricothyrotomy.
Overview
Paramedic-level: ETT intubation, supraglottic airways, RSI, and cricothyrotomy. Defining paramedic skill tested extensively on NREMT Paramedic exam.
In prehospital assessment, SpO2 reference range: adult 95-100%, pediatric 95-100%. Deviations from these norms guide treatment decisions in the field.
Equipment & Tools
Equipment used in advanced airway management assessment and treatment:
- Waveform capnograph
- Measures end-tidal CO2 continuously with waveform display. Available sizes: Mainstream (inline), Sidestream (sampling)
- AED
- Automated external defibrillator for VF/pVT. Available sizes: Adult pads (over 8yo or 25kg), Pediatric pads (under 8yo or 25kg)
- Pulse oximeter
- Measures SpO2 via infrared absorption through capillary bed. Available sizes: Finger clip, Earlobe, Pediatric wrap
- King airway
- Supraglottic blind-insertion airway device. Available sizes: Size 3 (4-5 ft), Size 4 (5-6 ft), Size 5 (over 6 ft)
Documentation
Documentation of advanced airway management in the patient care report (PCR) must include: time of assessment, findings, interventions performed, patient response, and reassessment findings. Use objective, measurable terms like "patient reports 8/10 chest pain" rather than "patient in pain." Document pertinent negatives. All medications administered must include drug name, dose, route, time, and patient response.
Common Errors
Critical errors in prehospital application of advanced airway management:
- Failing to reassess after intervention. Vital signs must be rechecked every 5 minutes for unstable patients
- Incorrect medication dosing. Always use length-based estimation (Broselow tape) for pediatric patients
- Tunnel vision on one finding while missing the complete clinical picture
- Not communicating changes to receiving facility during transport
Key Values & Ranges
Key values and ranges relevant to advanced airway management in prehospital care:
| Parameter | Adult | Pediatric |
|---|---|---|
| blood glucose | 70-140 mg/dL | 60-100 mg/dL (neonates lower) |
| blood pressure | 90/60-120/80 mmHg | 70+(2*age) systolic minimum |
| ETCO2 | 35-45 mmHg | 35-45 mmHg |
| GCS | 15 is normal, under 8 = severe TBI | modified pediatric GCS for preverbal |
| temperature | 97.8-99.1 F (36.5-37.3 C) | same range, rectal preferred under 2yo |
Assessment Techniques
Assessment techniques for advanced airway management:
- Cincinnati Stroke Scale
- Components: Facial droop, Arm drift, Speech abnormality. Scoring: Any 1 positive = 72% probability of stroke
- Glasgow Coma Scale
- Components: Eye opening (1-4), Verbal response (1-5), Motor response (1-6). Scoring: 3-15, 8 or less = severe, 9-12 = moderate, 13-15 = mild
Why It Matters
Defining paramedic skill tested extensively on NREMT Paramedic exam.
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