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Advanced airway management techniques

Maintaining skills in using advanced airway items can improve your practice

Advanced airway is a low frequency skill with a very high potential of risk. If this skill is incorrectly performed, it could be detrimental to the outcome of your patient. Endotracheal intubation was once considered the preferred method of advanced airway management. However, that may not be true anymore.

There are many ways to perform advanced airway management. Endotracheal intubation is slipping further away as other advanced airways are becoming more frequently utilized. It is important for all providers that have this in their scope of practice to be the master of their own skills proficiency. You should not wait for the annual proficiency test performed by your Medical Director/EMS Chief. AHA recommendations state that if you do not perform a minimum of 20 ET intubations in a calendar year, you should not be performing this skill. It is important for the provider to practice this skill every shift in order to be proficient enough in this skill to assure the patient receives the proper care.

Other advanced airways include supraglottic airways like the Combitube, King Airway, LMA, and the new iGel. These devices may be just as detrimental to the patient if improperly placed. However, they may provide equal airway management in certain patients and allow chest compressions to continue without interruption. There is some speculation that supraglottic airways that have a hypopharyngeal cuff may be compressing the oxygenated blood flow to the brain, and studies are currently being performed to identify if this is true.

The medic should know how to utilize all of these advanced airways correctly and also be proficient in their skills if they are going to insert them in their patients. AHA states that these skills should only be performed if basic ventilatory methods are ineffective. In the below video, we will review the common advanced airways.

Jon Puryear, NREMT-P, has been active in EMS since 1983. He has been an active paramedic since 1992 including being an educator and Field Training Officer for several employers. He was the Assistant to the Medical Director for Dr. John Griswell in Ft. Worth, Texas, for EPAB/MedStar EMS and the Education/Clinical Coordinator for CareFlite in the Dallas/Ft. Worth Metropolitan area. Jon is the owner of Jon Puryear EMS CE, performing online live streaming and recorded EMS CE classes and refreshers. The live online classes are taught in a virtual instructor-led online live classroom, which allows the student to participate in “real time.” These classes may be taken from any computer or iPad/Apple TV with internet access and no travel is required. Many recorded classes are available in his online Learning Management System. Jon performs a 16 hour NREMT prep onsite to initial programs, and also a recorded version online designed to prepare students for their NREMT written examination. You may contact Jon and obtain more information about his services at

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