5.1P Upper Airway Obstruction-- Pediatric

EMT STANDING ORDERS 

1.0 Routine Patient Care 

See 5.3 Tracheostomy Tube Obstruction Management, if applicable.

ADVANCED EMT STANDING ORDERS

• Determine presence of upper airway obstruction (stridor):

• If the obstruction due to a foreign body is complete or partial with inadequate air exchange:  Follow ECC guidelines for foreign body obstruction. Maintain an open airway, remove secretions, vomitus and assist ventilations as needed. 

• If partial obstruction due to a foreign body is suspected and the child has adequate air exchange: transport to appropriate medical facility. Do not attempt to remove foreign body in the field.

• If suspected croup (barking cough, no drooling) or epiglottitis (stridor, drooling), maintain an open airway, place child in position of comfort and avoid upper airway stimulation. 

MEDICAL CONTROL MAY ORDER

•      Emergent removal of tracheostomy tube, if present, and evidence of obstruction resulting in inadequate air exchange. See 5.3 Tracheostomy Tube Obstruction Management for more information.

PARAMEDIC STANDING ORDERS

• Provide advanced airway management if indicated for mechanical obstruction: perform direct laryngoscopy if foreign body is suspected. If foreign body is visible and readily accessible, attempt removal with Magill forceps. If unable to remove obstructing foreign body, continue BLS airway management by providing positive pressure ventilations. 

• If foreign body is removed, proceed with endotracheal intubation if necessary and perform capnography. 

• If unable to clear airway obstruction, unable to intubate as needed or unable to perform positive pressure ventilations, perform a needle cricothyrotomy, if permitted under 6.3 Needle Cricothyrotomy.

• Nebulized racemic epinephrine 11.25 mg in 2.5ml normal saline, for suspected severe croup, with stridor at rest and respiratory distress.

Red Flag: For patients under 12 years old, the airway is in most cases best managed with a BVM or SGA. In some cases, intubation may be preferred. This is at the discretion of the treating paramedic.