Respiratory emergencies are among the most critical patients you will encounter as an EMS professional. If the patient is unable to maintain airway patency, or you are unable to correct the underlying issue, there is no hope for his or her recovery. And when these critical situations are compounded by complications in the field, your patient's chances are reduced even further.
Anyone who has worked in EMS knows that complications are inherent to the field. Emergency scenes by their nature are complex, often dangerous situations. For patients experiencing a respiratory emergency, there is little room for error. Complications that arise must be identified, addressed, and corrected immediately. But before we proceed with how to address such events, let's first identify some common complications associated with respiratory emergencies.
Equipment Complications
You are only as good as your equipment, so be sure those tools used in respiratory emergencies are fully functional. These include:
- Portable suction machine
- Intubation equipment
- Oxygen and O2 supplies
- Cardiac monitor
- Capnography monitor
To ensure these tools are ready, remember to:
- Check at the start of each shift.
- Keep extra supplies on hand for replacement and large-scale emergencies.
- Replace low batteries and have extra backups.
- Make sure equipment is clean and disinfected.
Patient Complications
Respiratory emergencies can be compounded by certain patient attributes and situations. Whether it’s the patient’s physical makeup or the scene itself, complications can arise on just about any call. Be alert for such complications when you encounter the following:
- Obese patients with short necks – usually associated with difficult intubations
- Pediatric patients – their infrequency can mean apprehension and unfamiliarity on the part of the rescuer
- Elderly patients – usually accompanied by multiple medical issues that may compromise airway and respirations (for example, stroke, COPD, and physical deficits)
- Mass-casualty events – can overwhelm resources, especially when they involve respiratory irritants like smoke or chemicals
- Confined spaces – entrapped patients who cannot be immediately/safely repositioned
Overcoming Complications
If there’s one thing that EMS professionals rely on every day, it’s improvisation. Few medical emergencies go “by the book.” You must be flexible in your approach to patient care, because these emergencies can occur at any time, at any place, and under just about any condition. Being able to think on your feet is critical to overcoming complications. And when the complications affect the patient’s respiratory efforts, there is no time to lose. Here are a few key considerations:
- Think ahead – through training and practice, you can prepare for any type of respiratory complication. Incorporate different types of airway adjuncts into your mega-code scenarios so that when a complication arises (can’t get the tube!), you can quickly move on to an alternative (Combitube or King).
- Make it real – we tend to practice airway techniques in the cool comfort of a classroom. Next time, position the patient (mannequin) in a vehicle, during the scorching heat of the day, or late at night in the dark. By incorporating realistic conditions into your practice scenarios, you’ll be better able to acclimate when the actual events occur.
- Have the right tools – the only way to overcome respiratory complications in the field is to have the necessary tools on hand. We all tend to be complacent from time to time, but when faced with a respiratory emergency, there is little time to correct a complication. Be sure your airway bag is fully stocked and your equipment is in good condition. Have plenty of adjuncts on hand so that you have choices.
- Bring the suction unit! If the airway complication is the result of obstruction (blood, phlegm, or tissue), there is only one way to correct it: your portable suction unit. But the unit is of no use to you if it’s left on the truck. Bring it with you on each call, or better yet, keep a compact unit in your airway bag so that it’s always available. Effective suction is the only means of clearing the airway, so don’t get caught without it!
Complications in the field are going to occur. And sooner or later, they will involve the respiratory system. So, in order to overcome your next respiratory complication, do a bit of preplanning and training, have the right tools on hand, and be sure to bring those tools with you on every call.
