Condition | Maneuver | Comments |
Foreign body with acute airway obstruction¶ | Back blows/chest thrusts (<1 year of age) | Maneuvers should only be used for patients who are unable to phonate. |
Abdominal thrusts (≥1 year of age) | Maneuvers should only be used for patients who are unable to phonate. | |
Manual removal with finger sweep | Perform this maneuver only when a foreign body is visible in the oropharynx. | |
Laryngoscopy and removal with Magill forceps | ||
Needle cricothyrotomy | For patients with complete obstruction not rapidly relieved by the above actions and who have a supraglottic foreign body, this procedure is a temporizing measure that can provide oxygenation but not ventilation. | |
LaryngospasmΔ | Positive pressure with a ventilation bag and tight-fitting mask | Additional measures such as rapid sequence intubation or needle cricothyrotomy may be necessary if laryngospasm persists despite bag-mask ventilation. |
Soft tissue upper airway obstructionΔ | Head tilt/chin lift | Avoid in patients who may have cervical spine injury. |
Jaw thrust | Use for patients who may have cervical spine injury. | |
Nasopharyngeal airway | Use for conscious or unconscious patient. | |
Oropharyngeal airway | Use only in an unconscious patient. | |
Respiratory failureΔ | Bag-mask ventilation | Suspect upper airway obstruction if unable to ventilate with proper size equipment and technique. |
High-flow nasal cannula◊ | Use for spontaneously breathing patients with hypoxemic respiratory failure without hypercarbia. | |
Noninvasive ventilation§ | Use for spontaneously breathing patients with hypoxemic or hypercarbic respiratory failure. Contraindicated in children with upper airway disease, high risk for aspiration, or hemodynamic instability. | |
Endotracheal intubation¥ | Use for patient in respiratory failure requiring more than a few minutes of bag-mask ventilation, those with impending airway compromise (eg, thermal burns, severe epiglottitis, or airway trauma), and/or those who are unconscious or have altered mental status with an absent gag reflex. In a patient with an airway that is manageable with bag-mask or noninvasive ventilation, chest compressions and vascular access should be prioritized over intubation. | |
Tension pneumothorax | Needle thoracentesis | Patients will require chest tube or pigtail placement following emergency decompression. |
Cardiac tamponade | Pericardiocentesis‡ | Use ultrasound guidance whenever available. |
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