Out-of-Hospital Airway Protocol
Determine need to assist ventilations
Face mask or BVM with Oxygen
Insert oral airway
Gag
No Gag
Insert nasal airway(s)
Continue ventilations
With face mask or BVM
Insert advanced
airway (*check placement)
Secure tube
Clenched Teeth
If seizure activity
administer versed
Post-intubation sedation may be required for treatment of anxiety and/or to prevent extubation by the
patient ONLY after the tracheal tube is confirmed and secured. Midazolam (Versed) Mix 5mg (1 milliliter)
with 9 milliliters of normal saline for a concentration of 0.5 mg/ml; give 1 milliliter (0.5 mg) initial dose
then repeat every 10 to 15 minutes slow IV push. Adjust dose to maintain adequate sedation and a systolic
blood pressure above 90.
Unsuccessful
Ventilate with oxygen
Reattempt intubation
Maximum number of intubation attempts: 3
Proceed to blind insertion device
Unsuccessful
Insert King Airway
or
Combitube
or
LMA
Determine placement and secure device*
Unable to ventilate
Perform Retrograde Intubation
See protocol
Unable to secure airway
Go to cricothyroidotomy
Out-of-Hospital Airway Protocol
Confirmation of Airway Device Placement
Insert Tracheal Tube, King Airway, Combitube or LMA
Apply Capnography
Waveform present
Auscultate epigastrium,
and lung fields and
observe for chest rise.
Equal breath sounds and
Chest-rise present
Waveform present
Secure tube
Maintain normal CO2 with ventilation
Apply cervical collar
Apply pulse oximeter
Reassess Frequently
Revised 3/29/2011
No waveform:
leave tube in place
visualize cords and
re-attempt