By Dennis Edgerly, EMT-P | Paramedic Education Coordinator
As you enter the house your patient looks at you anxiously. He's sitting upright, leaning forward. You note circumoral cyanosis and obvious respiratory distress as he attempts to speak. As you approach, you place him on oxygen with no relief. Upon auscultation of his chest, you note wheezing throughout his lung fields. You and your partner begin to administer a common bronchodilator albuterol when you remember -- all that wheezes is not asthma.
By Andrew Merelman, BS, NRP, FP-C , Richard Levitan, MD, FACEP
You arrive on scene and find a 68-year-old man is lying on the couch with difficulty breathing. He’s obese and obtunded, with severe respiratory distress. His wife tells you he has a history of congestive heart failure. He appears pale and diaphoretic, with snoring, slow, shallow breaths and his initial oxygen saturation is 72%. What are the most important first steps in managing his airway and breathing?
By Keith Widmeier, BA, NRP, FP C
A difficult airway is one in which the EMS provider identifies potential attributes of the patient that would make it difficult to utilize a bag-valve mask (BVM), insert an extraglottic airway, perform a laryngoscopy, and/or perform surgical airway interventions. It's the ability to appropriately assess the patient's airway that allows providers to predict which will be difficult, optimize their first attempt and ensure the highest likelihood of success when managing a patient's airway. Thorough airway assessments help drive your clinical decision-making and help determine the tools you choose to wield when managing a particular airway.
By Jeremy Brywczynski, MD
A 9-1-1 call is received for a 68-year-old male with breathing problems. Upon arrival, the crew finds the patient confused but able to speak in short phrases. Initial vital signs are: BP 148/89, pulse 110 sinus rhythm, respiratory rate 28 and labored, O2 saturation 84% on room air and a fingerstick glucose of 145. The patient’s oxygenation and work of breathing improve markedly with 100% O2 by non-rebreather face mask. Physical examination is remarkable for increased work of breathing with rhonchi found bilaterally at the lung bases (worse on the left). No wheezing is present.
Subscribe to JEMS and get the latest insights and information about the world of Emergency Medical Services directly to your inbox including the latest news, features and educational content on prehospital airway management.