Intubation. Photo by Chanawit

10 Airway Tips and Tricks – Part 1

As simple as the concept of maintaining an airway may be, the real thing can be much more difficult. We all need a little boost to our game. Right up there with circulation, the airway is the most important thing for any patient and the EMS community should always encourage the sharing of any strategies that may make the job a little faster, a little easier, or a little more effective.

Here are 10 tips and tricks to help with those difficult airways. Some are simple, some a little more complex, some for EMTs and some for Paramedics, but all are helpful. Keep in mind to follow local protocols.

1) Sideways Intubation

I see many paramedics straining their neck to the left and right trying to see over their own hand and tube while holding and inserting it mid-line. Instead, enter from the side of the mouth. Your line of site is now clear and you can easily control the tip as you aim for the glottis and vestibular fold by simply rolling your fingers. (1).

2) Jaw Thrust or Head-Tilt Chin-Lift? Why Not Both?

Whenever going over two-person BVM in class you are always taught to use either the jaw thrust or head-tilt-chin-lift. Yet, in any situation that the head-tilt chin-lift is acceptable, so is the jaw thrust. So, use both!

To do this while bagging use your ring and pinky finger on each side of the jaw, pull up, hold the mask with your thumbs, and use your pointer fingers to open up the jaw. Then do the head-tilt chin-lift. (2).

This not only moves the tongue off the airway but gives you the most open airway. Just be sure to open up that jaw while you do this!

3) Stop Over-Pressurizing

Many of the newbies think more is better, especially when it comes to the amount of air in the lungs. However, over-pressurizing the lungs will pinch off pulmonary capillaries and begin to lower your blood pressure by decreasing the amount of blood available per beat of the heart. Ibid. As soon as you see the chest move, that’s enough! Stop there.

4) Use that nasal cannula!

While bagging an unresponsive, slap on a cannula as well. Whether the patient is breathing or not, the cannula can add a few cmH20 of PEEP and can hold your saturation levels for a good 1.5 minutes, should you need to stop bagging for some reason (like putting in an advanced airway). (3).

5) ALL THE ADJUNCTS! 

Want to make sure your patient is getting ventilated? Put in an airway adjunct. Want to really make sure? Drop in 3 adjuncts. The few more seconds you use to drop the additional adjuncts in are easily made up by not having constantly re-check the one airway you put in if you notice inadequate ventilation (4).

If you liked this list, keep an eye out for Part 2!

(Editor’s Note: The views expressed above do not necessarily reflect the views of EMS Wire)

  1. McConnel, Scott. “EMS Tips and Tricks 1.” YouTube. October 5, 2015. Accessed June 20, 2016. https://www.youtube.com/watch?v=ctPbnFMGOag.
  2. Maloney, Matt. “Airway Tips and Tricks 1.” YouTube. August 06, 2013. Accessed June 20, 2016. https://www.youtube.com/watch?v=3MGEg-cCvWc.
  3. Levitan, Richard, and Scott Weingart. “Preoxygenation, Deoxygenation and Reoxygenation during Intubation.” EMCrit. 2012. Accessed June 20, 2016. http://emcrit.org/preoxygenation/.
  4. . Weingart, Scott. “Podcast 65 – A Primer on BVM Ventilation with Reuben Strayer.” EMCrit, January 22, 2012. Accessed June 19, 2016. http://emcrit.org/podcasts/bvm-ventilation/.
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Tim Cheves
Born in Tucson, AZ, Tim received a B.S. degree in Physiology (Pre-Med) with a minor in Pre-law at the University of Arizona. Here, he co-founded two UA chapter medical outreach clubs, served as a pre-health ambassador, became an R&D researcher, competed on UA's triathlon team, received the “Physiology Wildcat Award” in 2012, and graduated with honors.

In addition to three separate associates degrees, Tim became a nationally certified EMT in 2008 and continues to use his certification to this day. His work experience spans from physical therapy and nursing tech to the ER, donor organ procurement, and Search and Rescue.
As a self proclaimed grease monkey and gym rat, Tim enters his self re-built cars into shows and competes in bodybuilding competitions for fun.

Tim has been an instructor for EMS University since 2014, works at the UA as a biosafety officer, and now sets his sights on becoming a Physician Assistant.

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