APPENDIX A: AIRWAY EQUIPMENT

Airway Equipment:

- Minimum (Ruck/Aid Bag): Nasopharyngeal airway, Cricothyrotomy kit; BVM with PEEP valve
- Better: Minimum PLUS supraglottic airway, gum elastic bougie to facilitate intubation, nasogastric/orogastric tube
- Best: Better PLUS endotracheal tubes or video laryngoscopy equipment is preferred (direct laryngoscope only if video equipment not available).1

Waveform Capnography:

- Minimum: Colorimetric ETCO2 detector
- Better: Portable capnometer
- Best: Waveform capnography on patient monitor

See Appendix G for Capnography Interpretation

Heat-Moisture Exchanger:

Heat-Moisture Exchangers (HME) are small, relatively inexpensive, in-line ETT adjuncts that contain hygroscopic salts that utilize differences in vapor pressure, expired moisture content, and the patient’s temperature to increase the humidity of inspired air. Increased moisture on inspiration helps maintain alveolar moisture. Capnography should not be positioned in-line following HME as these moisture devices can increase breathing resistance and work of respiration, as well as increase breathing apparatus dead space (especially in pediatric patients). This may lead to potential worsening hypercapnia and respiratory acidosis. Recommended order: endotracheal tube-capnograph-HME device (proximal to distal)

Nasogastric/Orogastric Tube:

Placement of a nasogastric (NG) or orogastric (OG) tube should be considered following intubation of a patient in order to decompress gastric contents, prevent aspiration and gastric distention.

- If only supraglottic airway access is available, consider using a supraglottic device that incorporates an orogastric tube port.
- Always measure the distance from nose to stomach and note the distance prior to insertion, then verify epigastric sounds. Verify placement with second practitioner if sounds are questionable or difficult to auscultate.
- Do not feed, aggressively hydrate or give oral medications through an OGT or NGT without telemedicine guidance. Always reassess tube position prior to putting anything into stomach to ensure proper gastric placement. Feeding should not be considered until 72 hours after injury in the PFC environment. If volume instilled is too large or rate is too fast, there is increased risk for vomiting. If feeding or hydration is begun through an OGT or NGT, they must be accurate, measured, and monitored. Safe airway management takes precedence over nutrition.

1. Prekker ME, Driver BE, Trent SA, et al. DEVICE Investigators and the Pragmatic Critical Care Research Group. Video versus direct laryngoscopy for tracheal intubation of critically ill adults. N Engl J Med. 2023 Aug 3;389(5):418-429