Respiratory

  • CPAP
  • OPA
  • Endotracheal Intubation
  • Supraglottic Airways
  • Surgical Cricothyroidotomy

CPAP

  • Background
    • Continuous positive airway pressure (CPAP) is a noninvasive ventilatory modality that can deliver mechanically assisted breaths without the need for intubation/surgical airway. 
  • Indications
    • Asthma, COPD, CHF (treatment of associated pulmonary edema), pneumonia.
  • Contraindications
    • Respiratory arrest, uncooperative patients, risk of aspiration, burns/facial trauma.
  • Complications
    • Decreased cardiac output, gastric distention, barotrauma
Video Credit: FD Collaborative Clayton, Englewood and Union

*Deep Dive: Non-invasive Ventilation (WikEM)



OPA

  • Background
    • Airway adjunct used to open the oropharynx and prevent the tongue from blocking the epiglottitis; thus improving BVM ventilation
  • Indications
    • Unresponsive patients w/o a gag reflex
  • Contraindications
    • Conscious patients or those with intact gag reflex
  • Complications
    • May induce vomiting, increasing the risk of aspiration. May also worsen airway obstruction if inappropriately sized.
Video Credit: Staffs Paramedics

*Deep Dive: Oropharyngeal Airway (PubMed)



Endotracheal Intubation

  • Background
    • Process of placing endotracheal tube for establishment of definitive airway. Traditionally considered the “gold standard” of airway management.
  • Indications
    • Failure to ventilate/oxygenative; inability to protect airway. May be placed in anticipation for future clinical courses (impending airway compromise, need for transport, etc.)
  • Contraindications
    • No absolute contraindications. However, benefits/risks of intubation should be considered in parallel with other airway strategies (supraglottic airways, surgical airways, NIPPV)
  • Complications
    • prolonged hypoxia, right main stem placement, esophageal placement.
Video Credit: Hippo Education

*Deep Dive: How To Intubate the Critically Ill Like a Boss (REBEL EM)



Supraglottic Airway

  • Background
    • Also known as “extraglottic airways”. These devices are inserted through the oropharynx to provide temporary airway ventilatory management, without passing the vocal cords. Common brands include the laryngeal mask airway (LMA), King Airway, and I-Gel.
  • Indications
    • Commonly used as a rescue device after failed intubation attempts, but may also be useful as a conduit for intubation or first-line for prehospital cardiac arrest. 
  • Contraindications
    • Gag reflex, spontaneous respirations, facial trauma
  • Complications
    • Ineffective placement, aspiration of gastric contents, pharyngeal edema
Video Credit: EM:RAP
Video Credit: intersurgical

*Deep Dive: Supraglottic Airway Review (emDOCs)



Surgical Cricothyroidotomy

  • Background
    • Procedure that involves placing a tube through an incision in the cricothyroid membrane to establish a patent airway, typically during life threatening situations.
  • Indications
    • Necessary when airway cannot be secured using nonsurgical methods (ex. Intubation, supraglottic); typically in the presence of severe facial trauma, swelling, or distorted anatomy. 
  • Contraindications
    • Patients under the age of 12. No absolute contraindications for adults.
  • Complications
    • Bleeding, thyroid injury, esophageal/mediastinal perforation, incorrect placement.
Video Credit: EMCRIT

*Deep Dive: The Sphincter Series: Emergent Cricothyrotomy (emDOCs)


Brandon Simpson, PA-S2
Latest posts by Brandon Simpson, PA-S2 (see all)