United States Department of Transportation

National Highway Traffic Safety Administration

Paramedic:  National Standard Curriculum

(Reprinted with permission)

http://www.nhtsa.dot.gov/people/injury/ems/

 

Airway: 2

Airway Management: 1

 

UNIT TERMINAL OBJECTIVE

2-1        At the completion of this unit, the paramedic student will be able to establish and/ or maintain a patent airway, oxygenate, and ventilate a patient.

 

COGNITIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

 

2-1.1     Explain the primary objective of airway maintenance. (C-1)

2-1.2     Identify commonly neglected prehospital skills related to airway. (C-1)

2-1.3     Identify the anatomy of the upper and lower airway. (C-1)

2-1.4     Describe the functions of the upper and lower airway. (C-1)

2-1.5     Explain the differences between adult and pediatric airway anatomy. (C-1)

2-1.6     Define gag reflex. (C-1)

2-1.7     Explain the relationship between pulmonary circulation and respiration. (C-3)

2-1.8     List the concentration of gases that comprise atmospheric air. (C-1)

2-1.9     Describe the measurement of oxygen in the blood. (C-1)

2-1.10   Describe the measurement of carbon dioxide in the blood. (C-1)

2-1.11   Describe peak expiratory flow. (C-1)

2-1.12   List factors that cause decreased oxygen concentrations in the blood. (C-1)

2-1.13   List the factors that increase and decrease carbon dioxide production in the body. (C-1)

2-1.14   Define atelectasis. (C-1)

2-1.15   Define FiO2. (C-1)

2-1.16   Define and differentiate between hypoxia and hypoxemia. (C-1)

2-1.17   Describe the voluntary and involuntary regulation of respiration. (C-1)

2-1.18   Describe the modified forms of respiration. (C-1)

2-1.19   Define normal respiratory rates and tidal volumes for the adult, child, and infant. (C-1)

2-1.20   List the factors that affect respiratory rate and depth. (C-1)

2-1.21   Explain the risk of infection to EMS providers associated with ventilation. (C-3)

2-1.22   Define pulsus paradoxes. (C-1)

2-1.23   Define and explain the implications of partial airway obstruction with good and poor air exchange. (C-1)

2-1.24   Define complete airway obstruction. (C-1)

2-1.25   Describe causes of upper airway obstruction. (C-1)

2-1.26   Describe causes of respiratory distress. (C-1)

2-1.27   Describe manual airway maneuvers. (C-1)

2-1.28   Describe the Sellick (cricoid pressure) maneuver. (C-1)

2-1.29   Describe complete airway obstruction maneuvers. (C-1)

2-1.30   Explain the purpose for suctioning the upper airway. (C-1)

2-1.31   Identify types of suction equipment. (C-1)

2-1.32   Describe the indications for suctioning the upper airway. (C-3)

2-1.33   Identify types of suction catheters, including hard or rigid catheters and soft catheters. (C-1)

2-1.34   Identify techniques of suctioning the upper airway. (C-1)

2-1.35   Identify special considerations of suctioning the upper airway. (C-1)

2-1.36   Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique of  tracheobronchial suctioning in the intubated patient. (C-3)

2-1.37   Describe the use of an oral and nasal airway. (C-1)

2-1.38   Identify special considerations of tracheobronchial suctioning in the intubated patient. (C-1)

2-1.39   Define gastric distention. (C-1)

2-1.40   Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for inserting a nasogastric tube and orogastric tube. (C-1)

2-1.41   Identify special considerations of gastric decompression. (C-1)


2-1.42   Describe the indications, contraindications, advantages, disadvantages, complications, and technique for inserting an oropharyngeal and nasopharyngeal airway (C-1)

2-1.43   Describe the indications, contraindications, advantages, disadvantages, complications, and technique for ventilating a patient by: (C-1)

1.                                           Mouth-to-mouth

2.                                           Mouth-to-nose

3.                                           Mouth-to-mask

4.                                           One person bag-valve-mask

5.                                           Two person bag-valve-mask

6.                                           Three person bag-valve-mask

7.                                           Flow-restricted, oxygen-powered ventilation device

2-1.44  Explain the advantage of the two person method when ventilating with the bag-valve-mask. (C-1)

2-1.45  Compare the ventilation techniques used for an adult patient to those used for pediatric patients. (C-3)

2-1.46  Describe indications, contraindications, advantages, disadvantages, complications, and technique for ventilating a patient with an automatic transport ventilator (ATV). (C-1)

2-1.47   Explain safety considerations of oxygen storage and delivery. (C-1)

2-1.48   Identify types of oxygen cylinders and pressure regulators (including a high-pressure regulator and a therapy regulator). (C-1)

2-1.49   List the steps for delivering oxygen from a cylinder and regulator. (C-1)

2-1.50   Describe the use, advantages and disadvantages of an oxygen humidifier. (C-1)

2-1.51   Describe the indications, contraindications, advantages, disadvantages, complications, liter flow range, and concentration of delivered oxygen for supplemental oxygen delivery devices. (C-3) 

2-1.52   Define, identify and describe a tracheostomy, stoma, and tracheostomy tube. (C-1)

2-1.53   Define, identify, and describe a laryngectomy. (C-1)

2-1.54   Define how to ventilate with a patient with a stoma, including mouth-to-stoma and bag-valve-mask-to-stoma ventilation. (C-1)

2-1.55   Describe the special considerations in airway management and ventilation for patients with facial injuries. (C-1)

2-1.56   Describe the special considerations in airway management and ventilation for the pediatric patient. (C-1)

2-1.57   Differentiate endotracheal intubation from other methods of advanced airway management. (C-3)

2-1.58   Describe the indications, contraindications, advantages, disadvantages and complications of endotracheal intubation. (C-1)

2-1.59   Describe laryngoscopy for the removal of a foreign body airway obstruction.  (C-1)

2-1.60   Describe the indications, contraindications, advantages, disadvantages, complications, equipment, and technique for direct laryngoscopy. (C-1)

2-1.61   Describe visual landmarks for direct laryngoscopy. (C-1)

2-1.62   Describe use of cricoid pressure during intubation. (C-1)

2-1.63   Describe indications, contraindications, advantages, disadvantages, complications, equipment and technique for digital endotracheal intubation. (C-1)

2-1.64   Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for using a dual lumen airway. (C-3)

2-1.65   Describe the indications, contraindications, advantages, disadvantages, complications and equipment for rapid sequence intubation with neuromuscular blockade. (C-1)

2-1.66   Identify neuromuscular blocking drugs and other agents used in rapid sequence intubation. (C-1)

2-1.67   Describe the indications, contraindications, advantages, disadvantages, complications and equipment for sedation during intubation. (C-1)

2-1.68   Identify sedative agents used in airway management. (C-1)

2-1.69   Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for nasotracheal intubation. (C-1)

2-1.70   Describe the indications, contraindications, advantages, disadvantages and complications for performing an open crichothyrotomy. (C-3)


2-1.71   Describe the equipment and technique for performing an open cricothyrotomy. (C-1)

2-1.72   Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for  transtlaryngeal catheter ventilation (needle cricothyrotomy). (C-3)

2-1.73   Describe methods of assessment for confirming correct placement of an endotracheal tube. (C-1)

2-1.74   Describe methods for securing an endotracheal tube. (C-1)

2-1.75   Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for extubation. (C-1)

2-1.76   Describe methods of endotracheal intubation in the pediatric patient. (C-1)

 

AFFECTIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

 

2-1.77   Defend the need to oxygenate and ventilate a patient. (A-1)

2-1.78   Defend the necessity of establishing and/ or maintaining patency of a patient’s airway. (A-1)

2-1.79   Comply with standard precautions to defend against infectious and communicable diseases. (A-1)

 

PSYCHOMOTOR OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

 

2-1.80   Perform body substance isolation (BSI) procedures during basic airway management, advanced airway management, and ventilation. (P-2)

2-1.81   Perform pulse oximetry. (P-2)

2-1.82   Perform end-tidal CO2 detection. (P-2)

2-1.83   Perform peak expiratory flow testing. (P-2)

2-1.84   Perform manual airway maneuvers, including: (P-2)

a.                     Opening the mouth

b.                     Head-tilt/ chin-lift maneuver

c.                     Jaw-thrust without head-tilt maneuver

d.                     Modified jaw-thrust maneuver

2-1.85   Perform manual airway maneuvers for pediatric patients, including: (P-2)

a.                     Opening the mouth

b.                     Head-tilt/ chin-lift maneuver

c.                     Jaw-thrust without head-tilt maneuver

d.                     Modified jaw-thrust maneuver

2-1.86   Perform the Sellick maneuver (cricoid pressure). (P-2)

2-1.87   Perform complete airway obstruction maneuvers, including: (P-2)

a.                     Heimlich maneuver

8.                                           Finger sweep

9.                                           Chest thrusts

10.                                       Removal with Magill forceps

2-1.88   Demonstrate suctioning the upper airway by selecting a suction device, catheter and technique. (P-2)

2-1.89   Perform  tracheobronchial suctioning in the intubated patient by selecting a suction device, catheter and technique. (P-2)

2-1.90   Demonstrate insertion of a nasogastric tube. (P-2)

2-1.91   Demonstrate insertion of an orogastric tube. (P-2)

2-1.92   Perform gastric decompression by selecting a suction device, catheter and technique. (P-2)

2-1.93   Demonstrate insertion of an oropharyngeal airway. (P-2)

2-1.94   Demonstrate insertion of a nasopharyngeal airway. (P-2)

2-1.95   Demonstrate ventilating a patient by the following techniques: (P-2)

a.                     Mouth-to-mask ventilation

11.                                       One person bag-valve-mask


12.                                       Two person bag-valve-mask

13.                                       Three person bag-valve-mask

14.                                       Flow-restricted, oxygen-powered ventilation device

15.                                       Automatic transport ventilator

16.                                       Mouth-to-stoma

17.                                       Bag-valve-mask-to-stoma ventilation

2-1.96   Ventilate a pediatric patient using the one and two person techniques. (P-2)

2-1.97   Perform ventilation with a bag-valve-mask with an in-line small-volume nebulizer. (P-2)

2-1.98   Perform oxygen delivery from a cylinder and regulator with an oxygen delivery device. (P-2)

2-1.99   Perform oxygen delivery with an oxygen humidifier. (P-2)

2-1.100 Deliver supplemental oxygen to a breathing patient using the following devices:  nasal cannula, simple face mask,  partial rebreather mask, non-rebreather mask, and venturi mask (P-2)

2-1.101 Perform stoma suctioning. (P-2)

2-1.102 Perform retrieval of foreign bodies from the upper airway. (P-2)

2-1.103 Perform assessment to confirm correct placement of the endotracheal tube. (P-2)

2-1.104 Intubate the trachea by the following methods: (P-2)

a.         Orotracheal intubation

b.         Nasotracheal intubation

c.         Multi-lumen airways

18.               Digital intubation

d.         Transillumination

e.         Open cricothyrotomy

2-1.105 Adequately secure an endotracheal tube. (P-1)

2-1.106 Perform endotracheal intubation in the pediatric patient. (P-2)

2-1.107 Perform transtracheal catheter ventilation (needle cricothyrotomy). (P-2)

2-1.108 Perform extubation. (P-2)

2-1.109 Perform replacement of a tracheostomy tube through a stoma. (P-2)

 

 


DECLARATIVE

 

I.          Introduction

1.         The body’s need for oxygen

2.         Primary objective of emergency care

a.         Ensure optimal ventilation

(1)        Delivery of oxygen

(2)        Elimination of CO2

3.         Brain death occurs within 6 to 10 minutes

4.         Major prehospital causes of preventable death

a.         Early detection

b.         Early intervention

c.         Lay-person BLS education

5.         Most often neglected of prehospital skills

a.         Basics taken for granted