Module #1 – Pre-hospital Airway Management Objectives

Clinical and Technical Skills.

Upon completion of module 1 – Airway Management – course participants should be able to complete the following:

1.0 Anatomy
1.1 Describe basic airway anatomy
1.2 Describe the differences between the pediatric and adult airway

2.0 Identify the need for definitive management including:
2.1 Anatomical obstruction.
2.2 Lack/loss of airway protection.
2.3 Projected clinical course necessitating definitive airway management prior to arrival at receiving hospital.

3.0 Perform an accurate airway assessment and develop a management plan including:
3.1 Identification of (potential) difficult BMV
3.2 Identification of (potential) difficult intubation
3.3 Identification of (potential) difficult supraglottic airway
3.4 Identification of (potential) difficult surgical airway
3.5 Describe algorithm for both difficult and failed airways.

4.0 Airway Management
4.1 Demonstrate use of Pre-RSI checklist
4.2 Clearly assign airway roles (ICP vs HEMS physician vs. Crewman)
4.3 Optimize pre-oxygenation (eg. Nasal trumpets/OPA/etc)
4.4 Optimize patient position
4.4.1 Helicopter vs. Ambulance vs. Roadside
4.4.2 Anatomical positioning
4.4.3 Scene management
4.5 Describe the pharmacology of the following RSI medications:
Induction Agent
4.5.1.1 Ketamine
4.5.1.2 Etomidate
4.5.1.3 Fentanyl
4.5.1.4 Midazolam
Neuromuscular Blocking Agent
4.5.2.1 Suxmethonium
4.5.2.2 Rocuronium
Pediatric specific medications
4.5.3.1 Atropine
Rescue Medications
4.5.4.1 Adreniline
4.5.4.2 Metarminol
4.6 Intubation
4.6.1 Use Cormack-Lehane grading system to describe view of glottic opening.
4.6.2 Demonstrate correct placement of ETT tube under direct vision.
4.6.3 Demonstrate effective use of bougie
4.6.4 Demonstrate a working knowledge of video-laryngoscopy
4.6.5 Demonstrate correct placement of supra-glottic airway device

4.7 Surgical airway
4.7.1 Demonstrate a working knowledge of appropriate surgical anatomy required to perform a needle/ open cricothyrotomy
4.7.2 Demonstrate appropriate surface land-marking required to perform needle/open cricothyrotomy.
4.7.3 List the equipment necessary to perform a needle/open cricothyrotomy.
4.7.3 Demonstrate a needle/ open cricothyrotomy.

4.8 Confirm correct placement of ETT
4.8.1 Understand use of ETCO2 for confirming placement of ETT
4.8.2 Describe alternative methods to confirm placement of ETT

4.9 Post –Intubation Care
4.9.1 Appropriate use of Post-RSI checklist
4.9.2 Demonstrate an appropriate technique to secure ETT for potential rough/turbulent transport.
4.9.3 Describe the pharmacology of the following post-intubation medication used to:
Sedated/ Analgesic for transportation:
4.9.3.1 Ketamine
4.9.3.2 Fentanyl/ Morphine
4.9.3.3 Midazolam
Neuromuscular Blockade for transport
4.9.3.1 Rocuronium

4.10 Transport
4.10.1 Formulate plan for potential complication related to/ during transport phase.