Emergent Airway Management

GENERAL PRINCIPLES

Recognition of the need to manage a patient's airway must be made in a timely and rapid fashion. Respiratory failure can occur suddenly and without obvious signs and symptoms.

Etiology

The need to emergently manage an airway typically arises because of:

• Loss of airway protective reflexes

• Respiratory failure

• Cardiopulmonary arrest

TREATMENT

• If the provider is not prepared to provide a definitive airway, temporary support of the airway should be performed.

• Basic maintenance of airway and/or ventilation is performed with:

î High-flow nasal cannula oxygen at 15 L/min

î Nonrebreather (NRB) oxygen mask at 15 L/min

î Bag valve mask (BVM)

• While preparing for definitive airway control/endotracheal intubation, the following steps should be performed:

î Place the patient upright to decrease dependent lung volume before intubation.

î Place the patient on NRB mask for 3 minutes if possible.

î If the patient needs ventilator assistance, deliver eight vital capacity breaths via BVM.

î Place a positive end expiratory pressure valve set to 5-20 cm H₂O on the BVM, which adds positive pressure to both bagging and passive oxygenation.