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 ACS Committee on Trauma Presents Airway and Ventilatory Management.

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Presentation on theme: " ACS Committee on Trauma Presents Airway and Ventilatory Management."— Presentation transcript:

1  ACS Committee on Trauma Presents Airway and Ventilatory Management

2 ©ACS

3

4 Objectives  Ensure adequacy of the airway  Confirm adequacy of ventilation  Define “definitive airway”  Maintain adequate oxygenation in all phases of airway management

5 ©ACS Key Questions  How do I know the airway is adequate?  How do I know ventilation is adequate?  How do I know oxygenation is adequate?  What are the pitfalls?

6 ©ACS Airway adequate? What if the patient ….  … talks clearly?  … is hoarse?  … cannot respond?  … is intubated?

7 ©ACS Patient talks clearly?  Airway is adequate  Management: Observation and selective intubation  High index of concern with  Maxillofacial injury  Soft-tissue injury of neck  Facial or neck burns

8 ©ACS Patient is hoarse?  Laryngeal injury  Laryngeal / tracheal burn  Management: Evaluate and perform  Careful endoscopic exam  Careful and gentle intubation, or  Surgical airway?

9 ©ACS Patient cannot respond?  GCS Score < 9  Obstruction due to  Tongue  Aspiration  Foreign body  Maxillofacial injury  Neck injury

10 ©ACS Patient cannot respond?  Cyanosis  Rocking respirations  Decreased or no air exchange  Face or neck crepitus  Neck hematoma or swelling

11 ©ACS Patient cannot respond?  Simple management maneuvers  “Definitive airway:” Cuffed tube in trachea  Suction  Chin lift  Jaw thrust

12 ©ACS Patient cannot respond?  Assess for signs of obstruction  Confirm correct ET tube position  Auscultate in medial axillae  Assess oxygenation (pulse oximeter)  Assess ventilation (CO 2 detector)  Obtain chest x-ray

13 ©ACS Definitve Airway  Airway protection  Coma  Maxillofacial  Aspiration  Obstruction  Ventilation  Apnoea  Poor Resp effort  Low 02  High C02  Cyanosis

14 ©ACS Caution Protect the cervical spine during airway management!

15 ©ACS

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17 Key Questions How do I know ventilation is adequate?  What do I see?  What do I feel?  What do I hear?  What do I measure?  What might I find?  How do I manage the patient?

18 ©ACS What do I see?  Respiratory rate and effort  Respiratory distress  Cyanosis  Restlessness / anxiety  Chest asymmetry

19 ©ACS What do I feel?  Crepitance  Local tenderness  Asymmetric respiratory excursion

20 ©ACS What do I hear?  Noisy breathing  Asymmetric breath sounds  Absent breath sounds

21 ©ACS What do I measure?  Mental status  Vital signs  Pulse oximetry  End-tidal CO 2  ABGs

22 ©ACS What might I find?  Tension pneumothorax  Pneumothorax  Hemopneumothorax  Malpositioned ET tube  Neurologic deficit  Direct neck / chest injury

23 ©ACS What might I find?  Signs of RTI/pneumonia  Signs of Asthma  Signs of CCF  Findings consistent with PE

24 ©ACS How do I manage the patient?  Establish an appropriate airway  Administer supplemental oxygen  Decompress the chest  Reposition the ET tube  Provide mechanical ventilation  Perform a surgical airway

25 ©ACS How do I manage the patient?  Treat the underlying cause

26 ©ACS Ventilation adequate?  Mental status evaluation  Vital signs  Pulse oximetry  ABGs

27 ©ACS

28 Summary  How do I know the airway is adequate?  How do I know ventilation is adequate?  How do I know oxygenation is adequate?  What are the pitfalls?


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