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 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