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The Stepwise Approach to PreHospital Airway Management: A Must-Follow Strategy

27 May 2023

When it comes to pre-hospital care, one of the most critical aspects is prehospital airway management . Properly managing the airway is crucial for maintaining adequate oxygenation and ventilation, ensuring patient safety, and improving outcomes. In this blog post, we will explore the airway management steps and why it should be an essential part of every pre-hospital care provider’s skillset.

Prehospital Airway Management Steps

Airway management refers to the process of ensuring an open and secure airway to facilitate adequate oxygenation and ventilation in a patient. The steps involved in airway management can vary depending on the specific situation and the level of expertise of the healthcare provider. However, here are the general steps commonly followed:

Assess the Situation

Before initiating any prehospital airway management technique, it is crucial to assess the situation. Evaluate the patient’s level of consciousness, airway patency, breathing pattern, and signs of respiratory distress. This initial assessment will guide your decision-making process and help determine the appropriate interventions.

Establish Basic Airway Manoeuvres 

In many cases, simple manoeuvres can open and maintain a patient’s airway effectively. Basic airway manoeuvres include head tilt-chin lift or jaw thrust manoeuvres to align the airway and clear any obstructions. These manoeuvres are non-invasive and can be easily performed

Jaw thrust should be performed over head tilt-chin lift if there is c-spine concern. 

Consider Supplementary Oxygenation 

Supplementary oxygenation is vital in pre-hospital care settings. Administering high-flow oxygen via a non-rebreather mask or nasal cannula can improve oxygen saturation and support respiratory function. Evaluate the patient’s oxygen saturation levels and adjust the oxygen flow rate accordingly.

Assess for Advanced Airway Management 

If the patient’s condition deteriorates or if basic airway manoeuvres are inadequate, advanced airway management techniques may be required. This can involve the insertion of an oropharyngeal or nasopharyngeal airway, or, in more severe cases, the initiation of endotracheal intubation or supraglottic airway device placement. These advanced techniques require proper training and expertise, and pre-hospital care providers should ensure their competency in performing them. 

[wpdiscuz-feedback id="uz7bcl003" question="Any tips?" opened="0"] When was the last time you performed an advanced airway? [/wpdiscuz-feedback]

Continuously Monitor and Adjust

Once an advanced airway is established, continuous monitoring is crucial. Monitor the patient’s oxygenation, ventilation, and capnography readings to ensure proper airway placement and adequate gas exchange. Regularly reassess the patient’s airway and adjust as needed to maintain optimal airway control.

Following a stepwise approach to airway management is essential in pre-hospital care. By systematically assessing the situation, employing basic airway manoeuvres, considering supplementary oxygenation, and, if necessary, implementing advanced airway techniques, pre-hospital care providers can optimize patient outcomes and ensure the best possible airway control.

Remember, regular training, competency assessment, and staying updated with the latest evidence-based practices are essential for delivering high-quality prehospital airway management.

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