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ACS Committee on Trauma Presents Airway and Ventilatory Management
Objectives Ensure adequacy of the airway Confirm adequacy of ventilation Define “definitive airway” Maintain adequate oxygenation in all phases of airway management
©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?
©ACS Airway adequate? What if the patient …. … talks clearly? … is hoarse? … cannot respond? … is intubated?
©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
©ACS Patient is hoarse? Laryngeal injury Laryngeal / tracheal burn Management: Evaluate and perform Careful endoscopic exam Careful and gentle intubation, or Surgical airway?
©ACS Patient cannot respond? GCS Score < 9 Obstruction due to Tongue Aspiration Foreign body Maxillofacial injury Neck injury
©ACS Patient cannot respond? Cyanosis Rocking respirations Decreased or no air exchange Face or neck crepitus Neck hematoma or swelling
©ACS Patient cannot respond? Simple management maneuvers “Definitive airway:” Cuffed tube in trachea Suction Chin lift Jaw thrust
©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
©ACS Definitve Airway Airway protection Coma Maxillofacial Aspiration Obstruction Ventilation Apnoea Poor Resp effort Low 02 High C02 Cyanosis
©ACS Caution Protect the cervical spine during airway management!
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?
©ACS What do I see? Respiratory rate and effort Respiratory distress Cyanosis Restlessness / anxiety Chest asymmetry
©ACS What do I feel? Crepitance Local tenderness Asymmetric respiratory excursion
©ACS What do I hear? Noisy breathing Asymmetric breath sounds Absent breath sounds
©ACS What do I measure? Mental status Vital signs Pulse oximetry End-tidal CO 2 ABGs
©ACS What might I find? Tension pneumothorax Pneumothorax Hemopneumothorax Malpositioned ET tube Neurologic deficit Direct neck / chest injury
©ACS What might I find? Signs of RTI/pneumonia Signs of Asthma Signs of CCF Findings consistent with PE
©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
©ACS How do I manage the patient? Treat the underlying cause
©ACS Ventilation adequate? Mental status evaluation Vital signs Pulse oximetry ABGs
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?
Chapter 2. Ensure adequacy of the airway Confirm adequacy of ventilation Define “definitive airway” Maintain adequate oxygenation in all phases.
Airway and Ventilatory Managment. Objectives Identify setting Regonize AWO Manage airway Define definitive airway.
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