In the hospital environment, patients can deteriorate rapidly and for many different reasons. Maintaining a patient's breathing is the main priority in any emergency situation, although achieving airway control can be difficult. All health professionals need to be able to undertake airway management safely. The key is a thorough assessment to ensure first of all whether the airway is patent (open and clear) or not. This article will discuss airway management, both acute and chronic, as well as associated nursing care.

Paramedics are at the frontline of healthcare delivery and this includes during the current coronavirus pandemic. This pandemic poses specific problems for paramedics, which include not only treating and transporting infected patients, but also issues around decontamination and disinfection of ambulances and medical equipment. Of particular concern is the pneumonia associated with the 2019 novel coronavirus. Data on COVID-19 pneumonia are developing. Ongoing research demonstrates that almost all serious consequences of COVID-19 feature pneumonia, especially in older people and those with comorbidities. Paramedics can have a profound effect on the care of patients with pneumonia. Effective management of COVID-19 pneumonia by the paramedic should centre around prompt recognition, early administration of oxygen and intravenous fluids and transfer to hospital. In some situations, paramedics may need to be involved in the delivery and maintenance of airway adjuncts in patients with COVID-19 pneumonia.

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It is usually the most obtund and critically ill of patients that receive paramedic pre-hospital endotracheal intubation. Without a patent airway, asphyxia will lead to death rapidly if not corrected. Pre-hospital endotracheal intubation is indicated in patients when there is—or a risk of—apnoea, upper airway blockage and a need for safeguarding against aspiration due to a decreased Glasgow Coma Scale. Endotracheal intubation is currently routinely performed on cardiac arrest patients and traumatic injury patients by paramedics. However, rapid sequence intubation induction, as an advanced paramedical procedure, is not currently advocated for UK paramedic practice. Rapid sequence intubation differs from the normal method of endotracheal intubation in that it can be performed on originally conscious and/or semi-conscious patients and that it uses sedation and paralytic pharmacological agents coupled with protective airway manoeuvres to induce a state of sedation suitable to facilitate endotracheal intubation. This paper explores some of the issues surrounding whether it is feasible for paramedics to routinely perform RSI in the future.

Overview Sepsis is a potentially life-threatening complication of an infection and involves a complex array of inflammatory responses. Sepsis is usually caused by bacterial, viral, or fungal infections that are likely to develop into pneumonia, abdominal infections and kidney infections. Sepsis has gained increasing publicity in recent years and is now a strong focus of clinical education following the launch of the ‘Surviving Sepsis’ campaign. Paramedics need to understand the pathophysiological process associated with sepsis, and how these may present in patients.