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Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital.

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Presentation on theme: "Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital."— Presentation transcript:

1 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital Care Providers Sixth Edition for Prehospital Care Providers Sixth Edition Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Chapter 4 Initial Airway Management Chapter 4 Initial Airway Management

2 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Initial Airway Management

3 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Overview Respiratory anatomy and physiology Importance of observation Supplemental oxygen, various airway adjuncts Indications, contraindications, advantages, disadvantages Predictors of difficulty Mask ventilation and endotracheal intubation Sellick maneuver Essential components of airway kit 2Airway -

4 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Initial Airway Management Most important trauma care task Challenging in field Frequently time critical Unpredictable Need options and alternatives Always start with basics 3Airway -

5 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology 4Airway -

6 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology 5Airway - Nasopharynx Delicate Turbinates Oropharynx Hyoid bone Hypopharynx Epiglottis

7 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology 6Airway - Larynx Laryngeal prominence Vocal cords Thyroid cartilage Cricoid cartilage Sellick maneuver Cricothyroid membrane

8 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology Trachea, bronchi Carina Mainstem bronchi Protective reflexes Lungs Pleural space Alveolocapillary membrane 7Airway -

9 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Average Adult Distances can vary by several cm. 2–2.5 cm movement in flexion/extension 8Airway -

10 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Patent Airway Airway -9 Without a patent airway, all other care is of little use. Without a patent airway, all other care is of little use.

11 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Patent Airway Continual observation Suction with large-bore tubing Airway adjuncts Nasopharyngeal airway Oropharyngeal airway Blind insertion airway device (BIAD) Endotracheal intubation 10Airway -

12 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Difficult Airway Rapid sequence intubation (RSI) BVM ventilation and immediate transport Assessment of difficult airway Remember MMAP MMallampati MMeasurement AAtlanto-occipital extension PPathology 11Airway -

13 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ MMAP: Mallampati Score 12Airway -

14 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ MMAP Measurement Chin to hyoid bone Opening of mouth Lower-jaw protrusion Atlanto-occipital extension Only if cervical-spine injury not suspected Pathology Anatomic airway obstructions 13Airway -

15 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Patent Airway Airway -14 Noisy breathing is obstructed breathing. Noisy breathing is obstructed breathing.

16 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Normal Perfusion Normal oxygenation PaO 2 : 100 mmHg Pulse oximetry Goal: maintain SpO 2 >95% Monitor SpO 2 with all trauma patients Monitor SpO 2 with any respiratory compromise 15Airway -

17 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Supplemental Oxygen % OxygenDeviceFlow Rate 40–50%Simple Face Mask10–12 lpm 60–90%NRB Face Mask12–15 lpm 25–30%Nasal Cannula2–6 lpm 40–50%BVM12–15 lpm 90–100%BVM with Reservoir Bag12–15 lpm 100%FRPPVD40 lpm 16Airway -

18 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Normal Ventilation Tidal volume (V T ) Amount moved with each breath 400 to 600cc (adult) V T x breaths/minute = Minute volume 500cc x 12 breaths/min = 6 liters/min (adult) Fast, shallow: 250cc x 24 breaths/min = 6 liters/min Slow, deep: 750cc x 8 breaths/min = 6 liters/min 17Airway -

19 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Normal Ventilation Normal ventilation Carbon dioxide in blood (pCO 2 ) 35–40 mmHg Abnormal ventilation Hypoventilation: pCO 2 above 40 mmHg Hyperventilation: pCO 2 below 35 mmHg Capnography End-tidal CO 2 (EtCO 2 ) relates directly to pCO 2 18Airway -

20 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 19Airway - When in doubt, give oxygen! When in doubt, give oxygen!

21 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Positive Pressure Ventilation rate 10–12 per minuteNon-intubated patient 8–10 per minuteIntubated patient Supplemental oxygen essential Suction must be immediately available Avoid gastric distention Monitor lung compliance 20Airway -

22 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Perfusion and Ventilation 21 Pulse oximetry (SpO 2 ) monitors oxygenation Monitor effectiveness Airway - Capnography (EtCO 2 ) monitors ventilation

23 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ B Beards O Obesity O Older patients T Toothlessness S Snores or stridor 22Airway - Difficult BVM Ventilation

24 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Airway Kit Airway adjuncts Various adjuncts Intubation kit Rescue airway device Portable suction Monitoring devices SpO 2 EtCO 2 Oxygen cylinder Oxygen delivery Cannula and masks Pocket mask BVM with reservoir bag 23Airway -

25 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Summary Ensuring a patent airway is essential. Need a clear understanding of anatomy, tidal volume, minute volume, compliance. Must be proficient in various techniques. Equipment must be immediately available. When in doubtgive oxygen! 24Airway -

26 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Discussion 25Airway -

27 Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Click for Next Chapter


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