Airway Adjuncts & Patient Outcome
Judson Smith, MSc, NREMTP, CCP
EMS Chief
Valle Ambulance District
Jefferson County, Missouri
One goal of the pre-hospital care provider is to manage a patient’s airway. In fact, this is the primary and most important goal in the pre-hospital arena. Airway adjuncts have grown from the oropharyngeal, nasopharyngeal and endotracheal tube to now include LMA’s, Combi-tubes and King Tubes. The question we must ask ourselves is, “Are we comfortable, proficient and capable of utilizing every tool available to secure a patient’s airway for a positive patient outcome?
Manual airway maneuvers, basic airway adjuncts and advanced airway adjuncts are drilled into us in EMTs and or Paramedic School but once we start working in the pre-hospital environment, some of these very important airway controls are used less and less causing most to have what could be considered less than proficient skills in airway management.
Crews should evaluate their abilities to utilize airway adjuncts on a regular basis. In the prehospital arena where we must have a strong knowledge in many fields, it is easy to develop bad habits that could cause the patient’s outcome to be less than desirable due to poor airway management. Some common mistakes include but are not limited to ventilating with too much volume or to fast. Some providers get caught up in the moment and lose focus on bag valve ventilation when in fact; it is the most important part of airway management. Having an incorrect facemask seal, failing to position the patients head/neck in the appropriate position to manage the airway as well as failing to use a Sellick maneuver are some mistakes that happen.
What causes a patient to by hypoxic? Believe it or not, it is not always caused by a failure to intubate but rather, it is often the result of a failure to property ventilate the patient. A patient’s is more likely to have a better outcome if he/she is being ventilated correctly with a...