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Student Guide
Airway Management
Essentials
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Airway Management Essentials

Student Guide
Learning Objectives NREMT Requirement
Cognitive Domain 1. Refresher
1. Applies knowledge (fundamental depth, foun- a. Patient assessment
dational breadth) of anatomy and physiology b. Medical/behavioral
to patient assessment and management in
c. Elective
order to assure a patent airway, adequate
mechanical ventilation, and respiration for pa- 2. Additional related CEs
tients of all ages.
2. Describe the various conditions that cause
concern during treatment in the field for essen-
tial airway intervention.
3. Discuss the various adjuncts available to main-
tain an open airway.
4. Describe the proper technique in using each of
the adjuncts.

Psychomotor Domain
1. Demonstrate how to properly use the various
types of airway adjuncts used by your
organization.

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Lesson Outline Notes

I. Review the assessment: Airway, Breathing, Circulation

A. Airway
1. Anatomy1
a. Oropharynx
b. Nasopharynx
c. Supraglottic
d. Trachea
e. Epiglottis
f. Vocal cords
g. Carina
h. Bronchi
2. Importance of establishing and maintaining the airway
a. Conduit for exchange of oxygen
b. Conduit for release of carbon dioxide
B. Breathing2
1. Definition
2. Process of
C. Circulation
D. Airway is always the priority – without the airway all other pro-
cesses do not matter.
II. Discuss the questions/concerns of pre-hospital airway manage-
ment.
A. Explain the “gold standard.”
1. Endotracheal intubation
a. Studies challenging effectiveness
b. Difficulty keeping up the necessary skill level
i. Too many providers
ii. Not enough patients for intubation
iii. Hospital reluctance for OR time
c. Potentially greater on-scene time
d. Poor conditions to perform skill
e. Prolonged attempts
f. Unrecognized errors in ETT placement
g. Adverse outcomes
B. Other methods of acceptable alternatives available
1. Greater number of personnel available to manage
airway
2. Patient must not have a gag reflex to use these
III. Review the tools available for controlling and maintaining an
airway.

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A. Laryngeal mask airways (LMA)3 Notes

1. Describe shape
2. Describe intended purpose
a. Widely used in the OR
b. Greater number of sizes
c. Tip slides into esophagus
3. Describe process of insertion and use
a. Blindly inserted
b. Seats itself after inflation of cuff
i. More prone to dislodgement
c. Cannot suction
d. Does not prevent aspiration
B. Dual Lumen4
1. Describe shape
a. Two tubes and two ventilation openings
2. Describe intended purpose
a. Can be placed in either the trachea or esophagus
b. Keeps tongue away from pharynx so air can flow
through trachea
3. Describe process of insertion and use
a. Inserted blindly
b. Ability to use either port depending on placement
c. Cannot use in children
d. May cause trauma
C. Supraglottic
1. Describe shape
2. Describe intended purpose
a. Designed to enter proximal esophagus
3. Describe process of insertion and use of King and Cobra
IV. Review pros and cons.
A. Conscious and unconscious
1. Intubated patients can be conscious
2. Alternatives – all patients are unconscious
B. Ability to suction5
C. Skill level needed for use of each device
1. Need to be proficient and competent on all methods
used, including a simple oropharyngeal or nasopharyn-
geal airway and BVM
2. Must have good judgment in deciding when to use each
one, when to change if one is not working, and when to
allow another provider to manage the airway
V. Priorities
A. The patient’s airway is the priority.

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B. Oxygenation is the second priority. Notes

C. Provider’s pride is never a priority.
1. If an airway is hard to manage, head to the hospital for
definitive care.
VI. Education and competency
A. Key to developing skill and good judgment
B. Develop airway management policies and protocols
C. Develop testing scenarios
D. Devise practice sessions
E. Practice, practice, practice

References
1
Shaun Fix (October 29, 2009). “Airway Management Essentials.”
Interview with Beth Crittenden (Producer). 24-7 EMS Quarter 4, 2010.
2
Limmer, Daniel, Michael F. O’Keefe, and Edward T. Dickinson.
“Chapter 19: Respiratory Emergencies.” Emergency Care. 12th
Edition. Upper Saddle River, NJ: Pearson/Prentice Hall, 2005.
443-468.
3
Barnes, Leageay, Joseph A. Ciotola, & Benjamin Gulli. “Chapter 40:
ALS Assist.” Emergency Care and Transportation of the Sick and
Injured, 10th Edition. Burlington, MA: Jones & Bartlett Learning, 2011.
1476.
4
Mistovitch, Joseph J., and Keith J. Karren. “Appendix 2: Advanced
Airway Management.” Prehospital Emergency Care, 10th Edition.
Pearson, 2014. 1276-1280.
5
Sanders, Mick J. “Chapter 15: Airway Management, Respiration, and
Artificial Ventilation.” Mosby’s Paramedic Textbook, Fourth Edition. St.
Louis, MO: Mosby, Inc. (Elsevier Inc.), 2012. 431-436.

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Patient Scenarios
Scenario 1:  It is a warm Saturday afternoon and a Scenario 4:  You and your partner just stopped for
911 call requests you respond to a fall victim. Your lunch when a 911 call is received to respond for a
response will take you to a remote area of a com- drowning victim at the local beach. You are advised
mon hiking trail. You are told that a young woman the patient is still in the water and the life guards are
was hiking with friends when she fell off of the path initiating a rescue. When you arrive, you find a life
into a stream. She is unconscious at this time. When guard carrying the patient up the beach. The patient
you arrive, you find a woman in her 20s lying supine appears limp.
in a small running stream.
Based on the information:
Based on the information: • What would your next step be to help stabilize
• What are the potential airway concerns? this patient?
• What would you do to stabilize the patient to • How would you determine the best method to
prepare her for transportation? manage his airway and provide oxygenation?
• What resources will you need to monitor her • What environmental conditions do you need to
airway, secure her for movement, and for consider when managing the airway?
transportation?
Scenario 5:  While returning from the hospital after
Scenario 2:  You are resting comfortably in a chair, dropping a patient off, you are dispatched to a local
reading an article on domestic violence in the latest manufacturing company for difficulty breathing.
professional emergency services magazine when a You arrive to find a male standing outside in acute
call comes in for an unconscious person in a hotel. respiratory distress. You are told by his co-workers
While responding, you are advised that the patient that he is asthmatic and was exposed to cleaning
is a 27-year-old female who is semi-conscious. You chemicals. Your initial assessment shows difficulty
are told she is breathing but her respiratory effort is breathing. During auscultation, you hear very little
labored. air movement in his large airways.
Based on the information: Based on the information:
• What methods can you prepare for to manage • How would you treat his medical condition?
this patient’s airway? • What would you do to manage his airway?
• What techniques or airway adjuncts do you • How would you ensure adequate oxygen
have available to manage the airway? exchange?
• In what order would you use these adjuncts?
• What other medical considerations should you
prepare for?

Scenario 3:  You and your partner are dispatched

for a motorcycle accident. You arrive and find a
young male lying in the roadway. He has a GCS of 9
with labored breathing. You note the motorcycle is
approximately 100 feet from where he is lying.
Based on the information:
• How would you manage this patient’s airway?
• What considerations will you use to make the
decision?
• What specific questions and concerns do you
have about managing this airway?

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Scenario Responses
The following scenario responses are suggested, and may not be complete. Always confirm your agency’s
treatment protocols

Scenario 1: • Injuries: Observe and assess:

Your patient is a 24-year-old female who slipped o Are there airway or breathing concerns?
off a trail approximately 15 feet above the stream. o Are there primary and secondary conditions?
She is breathing on her own; however, she has a
o What is the importance of initiating airway
GCS of 9. It is reported that she ate one hour before
management pre-hospital?
this incident. She does not move her lower extrem-
ities when evaluated but is able to move her upper o What questions can you ask to determine
extremities. Her vital signs are; pulse of 88, blood the circumstances surrounding this
pressure 108/48, and respirations of 24. situation?
• Medical concerns: The provider will attempt to • Treatment:
determine: o Ensure safety for you, your partner, and the
o What is the urgent airway situation? patient.
o What are the secondary concerns that will o Standard Precautions
impact airway management decisions? o Perform an assessment.
• Treatment: o Perform a thorough airway and primary as-
sessment.
o Ensure safety for you, your partner, and the
patient. o Ask good, objective questions.
o Standard Precautions o Perform a secondary assessment.
o Perform an assessment. o Initiate correct treatment.
o Perform a thorough airway and primary o Package, load, and transport the patient
assessment. appropriately and to the correct level of
care.
o Ask good, objective questions.
o Perform a secondary assessment. Scenario 3:
o Initiate correct treatment. Upon arrival, you find a young male lying in the
o Package, load, and transport the patient roadway. He responds to pain by flexion withdraw.
appropriately and to the correct level of He has abrasions and contusions on his chest and
care. arms. His chest is asymmetrical with inspiration.
Trachea is midline. Vital signs: Pulse 126, Blood
Scenario 2: Pressure 118/56, and respirations 28.
You arrive to find a young lady who is unresponsive. • Medical concerns: The provider will attempt to
It appears there are unidentified drugs near her and determine:
you suspect she has overdosed. After laying her su-
o What are the potential injuries of this
pine, she begins to vomit.
patient?
• Medical concerns: The provider will attempt to o How would you prepare this patient for
determine: treatment?
o What is the extent of the patient’s medical o How would you manage his airway?
condition?
o How would you determine when transpor-
o What pre-hospital airway options are avail- tation is necessary?
able for this patient?
o What basic techniques can you use to en-
sure an adequate airway?

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• Treatment: o Perform a secondary assessment.

o Ensure safety for you, your partner, and the o Initiate correct treatment.
patient. o Package, load, and transport the patient
o Standard Precautions appropriately and to the correct level of
care.
o Perform an assessment.
o Perform a quick trauma assessment. Scenario 5:
o Ask good, objective questions. When you arrive, you are led to a gentleman who is
o Perform a secondary assessment. experiencing an acute reaction to an exposure of
chemicals. He has a history of asthma. Upon evalu-
o Initiate correct treatment.
ation, you determine he is moving very little air. He
o Package, load, and transport the patient is gasping and trying to cough. He is unable to stay
appropriately and to the correct level of in one position as he attempts to breathe.
care.
• Medical concerns: The provider will attempt to
Scenario 4: determine:
This area of the beach is small and only three life o What are the urgent airway conditions?
guards protect a ¼-mile stretch. They were able to o What are the secondary concerns that will
reach and rescue the boy in a short period of time; impact airway management decisions?
however, he has been under water for about 2 min-
o What environmental concerns must you
utes. When you arrive, he is not breathing but does
consider?
have a weak pulse.
o Which airway management techniques
• Medical concerns: The provider will attempt to would be appropriate for this patient?
determine:
• Situation: Observe and assess:
o What are the medical priorities at the
o What is the medical condition of the patient?
scene?
o Are there any airway concerns?
o How would you determine the patient’s air-
way priorities? o Are there primary and secondary conditions?
o What airway management steps would you o What are your treatment options for the
take and when would you progress from patient?
non-invasive to invasive? o What are your transport priorities?
o What response would you expect from your • Treatment:
efforts and what would you change relative o Ensure safety for you, your partner, and the
to your airway management techniques as patient.
the patient improves or decompensates?
o Determine if there is an ongoing exposure
• Injuries: Observe and assess: situation.
o The extent and severity of the injuries o Standard Precautions
o Changes in patient condition and vital signs o Perform an assessment.
o Primary and secondary conditions o Perform a thorough airway and primary
o Determine treatment options for this patient assessment.
• Treatment: o Ask good, objective questions.
o Ensure safety for you, your partner, and the o Perform a secondary assessment.
patients. o Initiate correct treatment.
o Standards Precautions o Package, load, and transport the patient
o Perform an assessment. appropriately and to the correct level of
o Perform a quick airway and primary care.
assessment.
o Ask good, objective questions.

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