One of the most important clinical skills required by paramedics is airway management through intubation. Airway management is a critical basic skill required of clinicians, especially in the management of heavily sedated, unconscious, impaired consciousness, and anesthetized patients. Awake patients are able to maintain a patent airway by combining upper airway muscle tone and several reflexes that keep the trachea and larynx free from obstructions such as secretions. When patients lose consciousness, depending on the degree of impairment, muscle tone and upper airway reflexes are also lost. When upper airway reflexes are lost, either due to active vomiting or passive regurgitation, the person is at risk of losing the airway due to aspiration of regurgitated fluids. It may be necessary to protect the trachea or larynx from the consequences of regurgitation, either by inserting a tracheal tube at a point where upper airway reflexes return (as will be discussed in this essay), or by adjusting the patient's position attempting to minimize aspiration (Jenkins & Williams, n.d., p. 2). Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Loss of tone in the upper airway causes airway obstruction, which is usually caused by the tongue falling to a position more posteriorly in the pharynx, thus obstructing the airway. The obstruction can be a partial obstruction or a complete obstruction. Partial obstruction should be addressed to avoid complete obstruction that results in hypoxia over a short period of 1 to 2 minutes, with bradycardia and then death after a few minutes (Jenkins & Williams, n.d., p. 3). According to Petrou (2017, p. 17), respiratory complications such as those mentioned above are some of 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 include the following; cardiac arrest; respiratory arrest; patients with imminent and complete airway obstruction; the inability of the unconscious patient to safeguard his or her airway, such as during an overdose, coma, or ETOH; and the inability of the conscious individual to breathe adequately. One of the endotracheal contraindications is severe airway obstruction or trauma that does not allow safe passage of the endotracheal tube. In these cases emergency cricothyrotomy is indicated. Another endotracheal contradiction is the classification of Mallampati class 3 or 4 or anything else that may result in a potential difficult airway. A third contradiction is the injury of the cervical spine whereby the need for complete immobilization of the cervical spine makes endotracheal intubation complex (UnityPoint Health, n.d., p. 1). Emergency indications of orotracheal intubation include; respiratory arrests; cardiac arrest; inadequate ventilation or oxygenation; inability to protect the airway from aspiration; and anticipated or existing airway obstruction. Orotracheal intubation has very few contraindications, so it is somewhat contraindicated in a person who has a partial section of the trachea as the process can result in an entire tracheal section and loss of the airway. In such situations, surgical air management is necessary. Unstable surgical injury of the spine is not a contraindication. However, one must be maintained during intubationrigorous in-line stabilization of the cervical spine (Kabrhel et al., 2007, p. 1). The intubation process also has some side effects and disadvantages, so different intubation procedures have similar side effects. For example, endotracheal intubation may result in endobronchial intubation; ETT inserted too far from where it is needed; accidental intubation of the esophagus; and an incorrectly placed or improperly sized endotracheal tube, especially in an apnea patient, rapidly leading 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 has some complications, whereby the most adverse complication is unrecognized esophageal intubation resulting 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 pharyngeal stimulation. Trauma to the vocal cords, teeth, lips, and an exacerbation of cervical spine injuries may also occur (Kabrhel et al., 2007, p. 4). Some scholars have noted some of their reflections on airway management. For example, according to Caldiroli & Cortellazzi (2013, p. 84), they viewed some works and raised some issues such as the greater use of the supraglottic airway (SGA). Based on the data viewed, the two scholars state how complex airway management can be improved by following some implementation guidelines. Other scholars such as McCarthy & Cooper (2018) have had trouble understanding how to combine certain intubation techniques such as the Macintosh video laryngoscope, Bonfils intubation endoscope, and difficult airway. Aside from the thoughts and concerns raised, there is some discussion about the intubation process, with some debating whether paramedics should continue the intubation process. One of the reasons for this debate is because some paramedics performed the intubation process and the patient ends up dying due to some claims by pediatricians who have inadequate paramedic training related to airway management and due to negligence on the part of the EMS system ( Eckstein, 2010). . Many healthcare professionals also argue, to the contrary, that optimal conditions for intubation should be achieved before attempting intubation (Jacobs & Grabinsky, 2014). Intubation as a modality of airway management has had some developments in recent years. Endotracheal intubation (ETI) continues to be the primary standard for definitive airway management in the prehospital setting. According to numerous studies, the model of competent ETI requires universally accepted rigorous training and a more significant amount of experience in ETI (Jacobs & Grabinsky, 2014). Furthermore, a systematic evaluation of recent airway devices was performed. New airway devices come onto the market every year. These devices are designed to facilitate tracheal intubation or protect the airway (Isono et al., 2011, pp. 4-5). To ensure that proficiency in intubation techniques is maintained, as previously mentioned, all pediatricians should be trained and educated. Airway management is a complex skill, so it is critical that EMS providers are taught proper techniques early on and continue to practice the procedures taught. Management of all airways, including emergency airways, thoroughly requires a combination of skills such asthoughtful 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 adequate technique. The more the paramedic practices the intubation process, the more they perfect their intubation skills. Unfortunately, the opportunity to practice and gain such experience is limited as paramedic providers rarely have the ability to intubate. Additionally, the number of actual intubations a paramedic may need in the initial process during training may be minimal, and the amount of alternative airway tools requiring less training minimizes intubation frequency. Even if training is rarely used, highly critical skills are very useful and essential for maintaining skills. There are a few approaches to ensuring that training delivers the greatest impact on acquisition and retention. Additionally, initial airway training has traditionally involved the use of a mixture of group practice and lectures to assist students in acquiring the necessary skills. This practice was useful. However, it limited the perfection of the skill. It is essential that the initial training is then followed by consistent and repetitive practice and in increasingly realistic conditions. For example, after students practice with the head used for intubation on the table, it should be moved to the floor as this is where many patients will be positioned. Over time, the instructor should place the mannequin on a bed, on a stretcher, and wherever real patients are present. The equipment used should also mimic real-world situations. Multiple tubes should be made available to students so they can choose the size of tube to use (Hsieh, 2014). Students should also master accuracy. Highly technical processes such as endotracheal intubation require substantial practice to achieve the precise performance required. A performance that perfectly sets the stage for the student to then adapt to an adaptive environment. The student should be allowed to practice individually only after being approved by the instructor; otherwise, students should practice in pairs, observing each other as they attempt. Once you have achieved precision, you should start changing the conditions. Instructors should present scenarios in which students must decide whether to intubate or whether the airway can be maintained using basic life support or alternative airway tools such as the laryngeal mask airway or supraglottic airway. Additionally, there has also been interest in using high-fidelity simulation technology to help nurse and physician anesthetists acquire and retain airway management techniques. Simulation allows the educator to provide airways specific to student learning needs. Advanced airway management is a complex but precise task that requires high levels of expertise. Given the minimal frequency of contact with patients requiring intervention along with the high costs of complications when processes fail, it is critical that EMS providers learn proper techniques early on and continue to practice them (Hsieh, 2014). Intubation protocols are different in Institutions vary from case to case, with anesthesiologists being regularly involved, or not at all. The principles and objectives of the process are universal. However, the patient undergoing the procedure must be kept safe, the., 2016).