In this episode, we discuss airways with Dr. Rachel Ely, who is doing a rotation with CCEMS as an Assistant Medical Director as part of the military's EMS and Disaster Medicine Fellowship based at Brooke Army Medical Center in San Antonio. Dr. Ely has a background in EMS and actively worked as a paramedic for a few years before and during medical school. Passionate about all things "airway", Dr. Ely outlines some of her "must-dos" for a successful advanced airway while providing insight from her years of experience.
Before the call:
- Visualization and mental rehearsal
- Physical rehearsal: have a plan, and a backup, and a backup, and practice all of them
- Location of equipment is key
Airway preparation
During the call:
- Pre-oxygenate early. Once you decide they need an advanced airway, give all the oxygen.
- Resuscitate before you intubate, Laryngoscope as a Murder Weapon (Scott Weingart)
- Hypotension
- O2/Hypoxemia
- pH/acidosis. The apneic period can be deadly in certain patients. Recognizing this is trickier in EMS because you don’t have all the data (like blood gases). Fear this in the DKA patient, the septic shock patient, any metabolic acidosis
- Position the patient: it is worth your time to try do this right.
- The donut works, sometimes towels/pillows are needed, but just having a FF lift the head off of the floor will give you a 100% better view.
- Head off stretcher works for some, but may actually make things worse as the angle of oropharynx to glottis becomes more steep (glottis more anterior).
- Neck flexed, head extended gives optimal alignment
