Page 13 - 2026 SMOG

AIRWAY (ADULT/PEDIATRIC)
Signs and Symptoms of Distress and/or Failure
• SpO decreasing <90%, with/without ˚ Cyanosis
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supporting signs/symptoms of: ˚ Dysphasia
˚ Tachypnea ˚ Diaphoresis
˚ Tachycardia • Airway obstruction due to:
˚ Fever ˚ Trauma
˚ Cough ˚ Edema
˚ Adventitious breath sounds ˚ Excess secretions
Foreign body
Shock
˚
• Difficulty breathing or excess work of breathing ˚ ˚ Tongue
as demonstrated by: • Apnea
˚ Pursing lips • Decreased LOC (GCS <8)
˚ Accessory muscle involvement • Pediatric patients are <12 years of age
Treatment
• Reposition the airway via Jaw Thrust or Head Tilt Chin Lift. Provide shoulder padding for PEDs
if required
˚ Sweep (NOT BLIND) and suction as needed
ABD thrust or back slaps (for infants) if indicated
˚
• Assess the need for an advanced airway (suspected deterioration, SpO <90%, Burns with TBSA
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>40%, TBI with decreased LOC, TBI with suspected herniation, respiratory failure from disease/
infection/ injury)
• SpO <90%
2
˚ Start supplemental O 2
˚ Place NPA/OPA prn if no contraindications
˚ BVM or assist with respiration prn
˚
Recheck q5min
• Consider direct laryngoscopy to visualize foreign body obstruction; If present, remove, suction, and/
or provide abdominal compressions or back slaps for pediatric patients.
• Establish an advanced airway per procedure in the following sequence (move to the next procedure
per individual competencies, contraindications, and/or attempt failures)
˚ Endotracheal intubation
˚ Blind Insertion Airway Device (BIAD)
Cricothyroidotomy
˚
• After the first failed airway attempt
˚ Reassess interventions
˚ Restart protocol
Consider other causes
˚
• Continuous monitoring of EtCO , SpO , and ventilatory waveforms and pressures
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˚ Repeat sedative, analgesic, and paralytic per dose and time guidelines
• In the event of 2 failed airway attempts, conduct the following:
˚ If adequate ventilation with BVM is possible, continue BVM
˚ If adequate ventilation with BVM is NOT possible, perform cricothyroidotomy
PEARLS
• If able to ventilate with a BVM, insert an NPA or OPA, depending on contraindications, and continue
ventilating with a BVM
• Ventilate the patient at an age appropriate respiratory rate to maintain minute ventilation.
Reference: CPG ID: #12 (Burn Care); #39 (Airway Management of Traumatic Injuries); #80 (Airway
Management in PFC)
2026 Standard Medical Operating Guidelines (SMOG) • 5