Exploring emergency airway management techniques for paramedics

The ability to secure a patient's airway is crucial in the management of acutely life-threatening illnesses and injuries (Mulryan, 2011). Endotracheal (ET) intubation can be hazardous, particularly as patients may have deteriorated rapidly or have combined respiratory and cardiovascular failure. These forms of emergency situations are frequently encountered by paramedics, necessitating an acute awareness of their role in emergency airway maintenance.

Although supplementary oxygen can improve oxygenation and oropharyngeal airways can help maintain a patent airway, both require that the patient spontaneously breathes. However, when cessation of breathing occurs or when respiratory rate and effort is insufficient to maintain normal respiratory function, ET intubation may be required. Paramedics are required to competently achieve ET intubation in often time-critical situations, in less-than-ideal conditions.

Initially, in an emergency situation if simple techniques are not successful a bag valve mask may be the most effective way to assist ventilation. Paramedics need to be able to use this equipment by ensuring a tight seal is produced at the patient's face. This is done by using jaw thrust or maintaining the head tilt manoeuvre. Castle (1999) suggests that a two-person technique provides more effective ventilation for the patient. The success of this practice is dependent on the skill of the practitioner, as poor techniques could hamper efforts to maintain the airway. The airway should be cleared of foreign substances, such as sputum or vomit, through the use of suction. In the majority of cases the patient's airway is occluded by relaxation of pharyngeal and jaw muscles, causing tissue to dramatically narrow the airway and the tongue to fall backwards over the larynx. Therefore, by thrusting the mandible/jaw forwards, the tongue will be lifted away from the larynx, thus clearing a path for ventilation. Care should be taken when performing this manoeuvre on elderly patients, as pressure on soft tissues below the mandible during jaw thrust could inadvertently occlude the airway. This may be identified by visualising finger positions and any difficulty in ventilating (Figure 1).