One of the important clinical skills needed by paramedics is airway management through intubation. Airway management is an essential core skill required among physicians, particularly when caring for heavily sedated, unconscious, impaired consciousness, and anesthetized patients. Awake patients are able to maintain patency of their airways by a combination of upper airway muscle tone and several reflexes that keep their trachea and larynx free of obstructions such as secretions. When patients lose consciousness, muscle tone and upper airway reflexes are also lost depending on the degree of impairment. When upper airway reflexes are lost, either from active vomiting or passive regurgitation, the person is at risk of losing the airway due to aspiration of regurgitated fluids. The trachea or larynx may need to be protected from the consequences of regurgitation, either by inserting a tracheal tube to a point where upper airway reflexes return (as will be discussed in this essay), or by adjusting the patient's position by trying to make aspirations minimal (Jenkins & Williams, nd, p. 2). Say no to plagiarism. Get a tailor-made essay on “Why violent video games should not be banned”?Get the original essayLoss of tone in the upper airways leads to airway obstruction, which is usually caused by the tongue falling into a more posterior position in the pharynx, thus obstructing the airways. The obstruction can be either a partial obstruction or a complete obstruction. Partial obstruction must be treated to avoid complete obstruction which results in hypoxia within a short period of 1 to 2 minutes, with bradycardia and then death after a few minutes (Jenkins & Williams, nd, p. 3). According to Petrou (2017, p. 17), respiratory complications such as those mentioned above are among the most well-known emergencies for pediatricians who need knowledge of pediatric airway physiology for the required emergency care. Some of the intubations include endotracheal intubation. , orotracheal intubation and tracheal intubation. Indications for endotracheal intubation are: cardiac arrest; respiratory arrest; patients with imminent and complete airway obstruction; the inability of the unconscious patient to protect their airway, such as during an overdose, coma, or ETOH; and the inability of the conscious individual to breathe properly. One of the endotracheal contraindications is severe airway obstruction or trauma that does not allow safe passage of the endotracheal tube. In such cases, emergency cricothyrotomy is indicated. Another endotracheal contradiction is the Mallampati classification of class 3 or 4 or any other element that may determine a potentially difficult airway. A third contradiction concerns cervical spine injuries, in which the need for complete immobilization of the cervical spine makes endotracheal intubation complex (UnityPoint Health, n.d., p. 1). Emergency indications for orotracheal intubation include: respiratory arrests; cardiac arrest; inadequate ventilation or oxygenation; inability to secure the airway against aspiration; and anticipated or existing airway obstruction. Orotracheal intubation has very littlecontraindications, it is somewhat contraindicated in a person with a partial tracheal transection, as the process can result in complete tracheal transection and loss of the airway. In such situations, surgical air management is necessary. An unstable surgical lesion of the spine is not a contraindication. However, strict in-line cervical spine stabilization must be maintained during intubation (Kabrhel et al., 2007, p. 1). The intubation process also has some side effects and disadvantages, with different intubation procedures having similar side effects. For example, endotracheal intubation may result in endobronchial intubation; ETT inserted too far from where it is required; accidental intubation of the esophagus; and an improperly placed or sized endotracheal tube, particularly in an apneic patient, which quickly leads to hypoxia and death. Other side effects of endotracheal intubation include broken dentures or teeth and oropharyngeal trauma (UnityPoint Health, n.d., p. 1). Orotracheal intubation also causes some complications, with the most undesirable complication being unrecognized intubation of the esophagus, which results in hypercapnia, hypoxemia, and death. Laryngoscopy can trigger aspiration and vomiting of gastric contents, leading to pneumonia or pneumonia. Other side effects include bronchospasm, bradycardia, laryngospasm and apnea due to stimulation of the pharynx. Trauma to the vocal cords, teeth, lips and exacerbation of cervical spine injuries can also occur (Kabrhel et al., 2007, p. 4). Some researchers have noted some of their thoughts regarding airway management. For example, according to Caldiroli & Cortellazzi (2013, p. 84), they looked at some works and raised issues such as increased use of the supraglottic airway (SGA). Based on the data viewed, the two researchers explain how complex airway management can be improved by following certain implementation guidelines. Other researchers such as McCarthy & Cooper (2018) have struggled to understand how to combine certain intubation techniques such as the Macintosh video laryngoscope, Bonfils intubation endoscope, and difficult airway. In addition to the thoughts and concerns raised, there are some arguments surrounding the intubation process, where some question whether paramedics should continue the intubation process. One of the reasons for this debate is that some paramedics performed the intubation process and the patient ends up dying due to some allegations of pediatricians having inadequate paramedic training in airway management as well as negligence of the part of the EMS system (Eckstein, 2010). . Many caregivers also argue conversely that optimal intubation conditions must be met before attempting intubation (Jacobs & Grabinsky, 2014). Intubation as a means of airway management has seen some developments in recent years. Endotracheal intubation (ETI) continues to be the primary standard for definitive airway management in the prehospital setting. According to several studies, the model that masters ETI requires universally accepted rigorous training and a greater number of experiences in ETI (Jacobs & Grabinsky, 2014). In addition, recent respiratory devices have been systematically evaluated. Every year, new respiratory devices come onto the market. These devices aredesigned to facilitate tracheal intubation or secure the airway (Isono et al., 2011, pp. 4-5). To ensure competency in intubation techniques is maintained, as previously mentioned, pediatricians must all be trained and educated. Airway management is a complex skill, so it is essential that EMS providers learn proper techniques early on and continue to practice the procedures taught. Precisely managing all airways, including emergency airways, requires a combination of skills such as thoughtful clinical decision-making and excellent motor skills. ETI, for example, requires a sterile endotracheal tube that must be inserted directly into the trachea. A reliable ETI requires experience and appropriate technique. The more the paramedic practices the intubation process, the better their intubation skills become. Unfortunately, the opportunity to practice and gain such experience is limited because paramedic providers rarely have the opportunity to intubate. Additionally, the number of actual intubations a paramedic may require during the initial process while training may be minimal and the amount of alternative airway tools that require less training minimizes the frequency of intubation. Even though training is rarely used, highly critical skills are very essential to maintaining proficiency. There are certain approaches to ensure training provides maximum impact on acquisition and retention. Additionally, initial airway training traditionally used a mix of group practice and lectures to help students acquire the necessary skills. Such practice was useful. However, this limited the perfection of skills. It is essential that initial training is then followed by consistent and repetitive practice and under increasingly realistic conditions. For example, once students have practiced with the head used for intubation on the table, it should then be moved to the floor as this is where many patients will be positioned. Over time, the trainer should place the mannequin on a bed, on a stretcher, and anywhere real patients will be present. The equipment used should also mimic real-world situations. Multiple tubes should be made available to students so that they can choose which size tube to use (Hsieh, 2014). Students must also master accuracy. Highly technical processes like endotracheal intubation require extensive practice to achieve the precise performance required. A performance which perfectly constitutes a reference base so that the student can then adapt to an environment which adjusts him. The student must be allowed to practice individually after approval by the instructor only; otherwise, students should practice in pairs, with one observing the other as they attempt. As accuracy is achieved, one must begin to change the conditions. Instructors should present scenarios in which students must decide whether to perform intubation or whether the airway can be maintained using the basic life support system or alternative breathing tools such as the laryngeal mask or the supraglottic. Additionally, the use of high-fidelity simulation technology has also sparked interest in helping nurses and physician anesthetists acquire and retain airway management techniques. Simulation allows the educator to provide airways., 2016).