AIRWAY-SPECIFIC  Prolonged Field Care  NURSING  GUIDELINES / ASSESSMENT / TASKS

• Oral suction (or in-line/tube suctioning, if placed) as indicated during routine patient assessments
• Nose and mouth moistened every 4 hours
• Lip balm applied every hour
• Teeth brushed every 12 hours - Prevents pneumonia and other infections.
• Auscultate lungs every hour. If available, get a second medic to double check and verify if sounds are questionable or cannot otherwise auscultate. Extra diligence should be given to check for diminished breath sounds for suspected pneumothorax, as well as for pulmonary edema, especially if giving aggressive fluids in the case of a massive resuscitation, or replacement fluids. Consider ultrasound evaluation if available.²

Naso/Orogastric Tube (NGT/OGT) and Abdominal Care

(as applicable)

• Consider placing an NG/OG tube for prolonged care of intubated/cricothyrotomy patient or those with an Supraglottic Airway (SGA) device in place (if a compatible port is available on the SGA)
• Abdominal palpation AND auscultation every 2 hours.
• Appropriate placement must be confirmed before feeding or hydration is begun through NG/OG tube. If volume instilled is too large or rate too fast, there is a risk for vomiting.

References

1. Loos PE, Glassman E, Doerr D, et al. Documentation in prolonged field care. J Spec Oper Med. 2018; 18(1): 126-32.
2. Gottlieb M, Holladay D, Peksa GD. Ultrasonography for the confirmation of endotracheal tube intubation: a systematic review and meta-analysis. Ann Emerg Med. 2018;72(6):627-636.