Airway management: It’s not easy.
Catastrophic clinical failures, such as the one described in this article about Drew Hughes, serve as somber reminders about how challenging airway management truly is. Without an airway, patients do not live. Such a seemingly simple fact belies how difficult that can actually be to perform under a wide array of operating environments.
Yet trainers and educators often minimize the dangers of inadequate airway management. When asked by a student about the status of a scenario patient’s airway, we often respond with a simple statement, “The airway is patent.”
Such a straightforward response removes the responsibility of the student to truly affirm that the patient is able to maintain the airway on his own. If the student declares that the airway is patent, they should validate that statement by describing what was actually found. Scenarios should be built to allow students to make true decisions about how a patient’s airway should be monitored and managed to ensure patency.
Another favorite statement of educators and providers is to “not develop tunnel vision.”
I beg to differ. In cases where airway management is critical to the patient’s outcome, someone must take charge and focus on that aspect of patient care entirely. Given the chaos of a field operating environment, it’s simply too easy for even seasoned practitioners to lose track of the airway.
The DOPE — displacement, obstruction, pneumothorax, equipment failure — mnemonic is a simple tool to help rapidly diagnose the possibility of a failed airway.
Technology is another way to improve airway success. Monitoring exhaled carbon dioxide to confirm tube placement using a colorimetric device, like an Easy Cap, has been a mainstay practice for a long time. End-tidal waveform capnography is a relatively recent addition and considered more reliable. It’s also more expensive, but given the risk of overlooking a misplaced endotracheal tube and the cost to life and lawsuit, it seems to be a reasonable piece of safety equipment.
Airway management is all about using the right tool for the right patient at the right time. Whether as an advanced or basic provider, all EMS providers have the responsibility of knowing not only how to use all of the equipment at hand, but when to use it. Each device has its advantages and drawbacks. And each piece of airway equipment has the opportunity to cause harm if used incorrectly.
