EMS World

JUL 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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THE OPIOID CRISIS 46 JULY 2018 | EMSWORLD.com B ackup airways. Alternative airways. Rescue airways. Whatever we call them, we should know about them, have them, and use them. But do we know what we really need to know? In our ongoing experiences with both novice and experienced EMS practitioners, when it comes to alternative airways for pedi- atric patients, the answer too often is no. However, this is a potential shortfall in our education and training that can be easily remedied. We spend hours and hours perfecting our craf t in intubation, but how much time do we spend learning about backup air way devices? Have you ever actually looked at the package inser t or viewed the instructions? In actual practice we commonly base our use of devices on our training, which doesn't always reflect the manufacturer's recommendations. The truth is out there when it comes to these lifesaving devices. There is also much misinformation and many miscon- ceptions that can be easily corrected, if one knows where to look. It would be nice if critical information like what size air- way is suggested for what size patient and how much air should be used to inflate the balloon(s) were available in the same way with each type of device, but that's not the case. So with that in mind, let's review the essential questions that come up with the most commonly utilized pedi- atric emergency alternative air ways. Standardized Colors It's crucial to remember that the colors of the tops of alternative air ways do not cor- relate to the Broselow-Luten or Handte- v y systems. Three veterans of pediatric care—Robert Luten, MD, cocreator of the Broselow-Luten s ystem; Peter Antev y, MD, creator of the Handtev y s ys tem; and educator Scott DeBoer, lead author of this ar ticle—created char ts based on manufacturers' sizing recommendations that describe what color is for what size pediatric alternative air way (for Ambu's King and AuraGain, Mercur y Medical's air- Q sp, Teleflex's LMA Supreme, and Intersurgical's i-gel). These guides were provided to each of these manufacturers in the fall of 2017, and we hope in the future all manufacturers of alternative airways will embrace the inher- ent safety advantages of a standardized color-coded approach. Verifying Placement As with endotracheal tubes, it is always advisable to confirm proper placement of an air way adjunc t. Shor t of having x-ray vision, the most reliable techniques involve assessing the presence of car- bon dioxide in exhaled air. And do these colorimetric and capnographic devices work with a King air way, LMA, or i-gel? Absolutely! Quite simply, air goes in and out of these air ways (and hopefully your patient 's lung s) jus t like w ith an endotracheal tu b e. Co nf ir m in g co r re c t p l ace m e nt, both initially and on an ongoing ba sis, can be done with a colorimetric indica- tor or, preferably, waveform capnography. The standard of care is to monitor CO 2 with any endotracheal tube placement, so you can and should monitor exhaled carbon dioxide with any alternative air way to confirm placement as well. By Scott DeBoer, RN, MSN, CEN, CPEN, CCRN, CFRN, EMT-P; Michael Rushing, NRP, RN, BSN, CEN, CPEN, CFRN, TCRN, CCRN-CMC; Lisa DeBoer; and Michael Seaver, RN, BA PEDIATRIC ALTERNATIVE AIRWAYS: WHAT YOU NEED TO KNOW AND WHERE TO FIND IT The fi rst of a two-part series looks at colors, cuff s, and CO 2 Featured speaker at EMS World Expo, Oct. 29-Nov. 2, 2018, Nashville, TN. emsworldexpo.com

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