Page 183 - 2023 SMOG Digital

AIRWAY

Signs and Symptoms of Distress and/or Failure:
• SpO2 Decreasing or <90% (Room Air) with / without supporting Signs / Symptoms of:
o Tachypnea, Tachycardia, Fever, Cough, Wheezing, Rhonchi, Rales, Shock
• Difficulty Breathing or Excess Work as demonstrated by:
o Pursing of Lips, Accessory Muscle Involvement, Cyanosis, Decreased Ability to
Speak, Diaphoresis
• Airway Obstruction due to Trauma, Edema, Excess Secretions, Foreign Body, or Tongue
• Apnea

• Decreased LOC (GCS <8)
Continued from:

Tactical Evacuation Guideline or Respiratory Distress Guideline
Return to Guideline:
TACTICAL EVACUATION Indications of: Consider:
OR • Respiratory Distress / Failure Direct Laryngoscopy to
RESPIRATORY DISTRESS • Patient Unable to Protect Airway (GCS <8) visualize for foreign body
obstruction if Sweep, Suction
Airway Open? YES and Heimlich fail to open
• Continuous • Reassess NO airway
Monitoring Interventions Reposition Airway
• Repeat: • Restart Protocol (jaw-thrust for c-spine injury)
Sedative & • Consider other Sweep (not blind) & Suction as Return to Guideline:
Paralytic per Causes needed TACTICAL EVACUATION
dose and time FAILED AIRWAY Heimlich maneuver if indicated OR
guideline GUIDELINE RESPIRATORY DISTRESS
• Start Supplemental O2
YES Indication for Advanced Airway • Place OPA / NPA prn
YES • Sweep and Suction prn
Definitive Airway NO • Not Protecting Airway (GCS <8) • Recheck q5min n
Established and • Suspect Deterioration • BVM or assist with respiration prn
SpO2 >93% on O2? • Restart Guideline if de-
No compensating (SpO2 <90% on O2)
SpO2 >90%?
(Room Air) YES
Establish Advanced Airway per
Procedure in the following sequence: NO
(Move to next procedure per individual • Insert Nasopharyngeal Airway (NPA)
competencies, contraindications, and/or (If NO basal skull fracture suspected)
attempt failures) • Consider Placing OPA
1. ENDOTRACHEAL INTUBATION • Start Supplemental O2
• BVM (Assisted Ventilations) as needed Return to Guideline:
2. BIAD TACTICAL EVACUATION
Breathing Impacted by: OR
3. CRICOTHYROIDOTOMY
• Penetrating or Blunt YES CHEST RESPIRATORY DISTRESS
Chest Trauma OR TRAUMA • Recheck q5min
• Penetrating Abdominal Protocol • Advanced Airway if
Trauma? de-compensating
Consider: NO
RSI PROCEDURE if: SpO2 >93% on
• Intact Gag Reflex NO Supplemental O2? YES
• Conscious OR
• GCS >8
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