Many medical situations require emergency suction. And when you have a patient with an obstructed airway, be it from sputum, blood, vomitus, or tissue, you had better have the suction handy, for there is no other way to return the airway to patency.
There are three general scenarios — scenarios in which suction may not be the first thing that comes to mind – that are likely to require emergency suction. Here, we’ll discuss these common medical events and some of the guidelines to follow for each one.
1. Pediatric Emergencies
According to Stanford Children’s Health, the most recent statistics indicate that 88% of children who died from an airway obstruction injury were aged four or less. This makes sense when you consider the smaller the airway, the more likely it is to become obstructed. Small children are also susceptible to partial obstructions. From serious situations, such as epiglottitis, to simple sore throats that make it difficult to swallow, these smallest of patients may have difficulty clearing their airway, so be sure to have the portable suction unit on hand. Here are a few reminders:
- For patients suffering from epiglottitis, hold the suction catheter just outside the lip—you never want to insert anything into the child’s oropharynx (which may trigger constriction).
- Suction with care and use a small tip to maneuver within these smaller mouths and noses.
- If able, dial back the suction pressure, especially for infants and neonates.
- Be alert to hypoxia and keep suction time below 10 seconds.
- Never blindly insert a suction catheter into a child’s mouth during complete obstruction—you may accidentally force the obstruction deeper.
The next time you respond to a pediatric emergency, be sure to take the portable suction unit along, just in case.
2. Geriatric Patients
Geriatric patients make up a large proportion of emergency responses. And there are many reasons these patients may require emergency suction. They include:
- Commonality of respiratory issues in this age group, such as COPD
- Inability to swallow effectively due to natural deterioration or previous stroke
- Stroke emergencies that affect the physical or mental ability to protect the airway
- Cardiac arrest scenarios
Should you face an airway emergency requiring suctioning, here are a few reminders when suctioning your elderly patients:
- Be alert for dental hardware, which may become dislodged during suctioning—you don’t want to add an obstruction to your patient’s chief complaint.
- Use caution when suctioning—elderly oral tissues are prone to trauma and bleeding.
- Monitor your patient using every means available—oxygen sats, cardiac monitor, BP, capnography, and pulse.
- ALWAYS have the suction unit on hand in a code situation!
Like pediatrics, geriatric patients pose unique challenges, but a bit of caution and preplanning can help these calls run smoothly.
3. Trauma
One thing you can count on when working with a trauma patient is blood. Traumatic injury typically produces bleeding to some degree, internally, externally, or both. When the trauma involves the face, head, or neck, bleeding can quickly devolve into an airway emergency.
The suction unit may not be the first piece of equipment you consider when responding to a traumatic event. But as you grab your backboard and trauma bag, be sure to bring along the portable suction unit as well. Or better yet, keep a small suction unit in your trauma bag—that way, it’s always there, should you need it!
And remember to use the appropriate-sized catheter when clearing the airway of a trauma victim. A standard rigid catheter will probably not cut it. You’ll need a larger evacuation tool to handle the blood and tissue typical of facial trauma, so be sure to keep an assortment of catheters in your airway bag.
No matter the patient or the scenario, keeping your portable suction unit at your side is never a bad decision. Many situations can result in airway compromise, so stay alert and arrive prepared.
Editor's Note: This blog was originally published in April, 2017. It has been re-published with additional up to date content.
