Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø Failed airway protocol.
Ø Management of an airway when standard airway procedures cannot be accomplished or have failed in a patient 8 years or older.
Procedure:
a. Have suction equipment available and ready.
b. Locate the cricothyroid membrane utilizing correct anatomical landmarks.
c. Using your non-dominant hand, secure the membrane.
d. Prep the area with an antiseptic swab (Betadine).
e. Using a syringe and needle system (5cc syringe attached to a 10 to 14 gauge catheter-over-needle) insert the needle through the cricothyroid membrane at a 45° to 60° angle caudally (toward the feet).
f. Aspirate for air with the syringe while inserting the needle.
g. Once air returns easily, stop advancing the device.
h. Attach jet ventilation device. If jet ventilation is not available, attach the BVM to the barrel of the existing 5cc syringe (after removing the stopper) or replace with a 3cc syringe barrel and attach the BVM and ventilate.
i. Assess breath sounds while ventilating patient. Make certain that ample time is used not only for inspiration but expiration as well. Remember that a 1:4 inspiration/expiration ratio is normal.
j. Secure the needle by the best method available, recognizing that this method may be direct hands-on control of the device throughout the transport.
k. If unable to obtain an adequate airway (it is of the author’s opinion that this is never an adequate airway), resume basic airway management and transport the patient as soon as possible.
l. Notify the receiving facility as soon as possible of the need for a surgical airway regardless of the success of the procedure.
m. Document time, procedure, confirmation, and change in patient’s condition on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.