1. Airway and Ventilatory Managment

2. Objectives Identify setting Regonize AWO Manage airway Define definitive airway

3. Airway obstruction Coma Aspiration Facial trauma Neck trauma Picture of bomb to face

4. Airway Obstruction Regonition Look

5. Airway Obstruction Regonition Listen

6. Airway Obstruction Regonition Feel

7. Adequate Breathing Provide oxygen Subtle deterioration of breathing Caution! –Coma –SCI –Chest trauma

8. Inadequate Breathing LookListen

9. Inadequate Breathing FeelAdjuncts

10. Adequate oxygenation Requires –Oxygen –Definitive airway –Ventilation Caution –Protect C-spine

11. Airway Maintenance Chin lift Jaw thrust Oral airway Nasal airway

12. Definitive Airway Need for Airway –Coma –Maxillofacial injury –Aspiration –Airway injury Need for Breathing –Apnea –Hypoxia –Hypercapnia –Brain injury Definitive aw = cuffed tube in trachea

13. Definitive Airway Orotracheal Nasotracheal Surgical airway

14. Right Bronchial intubation Xray of right bronchial intubation

15. RSI Be prepared for surgical airway Requires skill and training Urgency must justify risk

16. Surgical Airway Indications –Inability to intubate the trachea –Maxillofacial trauma –Neck injury Methods –Needle –Surgical

17. Defnintive Airway: Immediate need: Apneic patient Protect c spin Oxgyenate ventilate Orotracheal intubation (No nasotracheal intubation b/c of apnea) If unable to intubate  surgical airway

18. Defnintive Airway: Immediate need: Breathing patient Protect c spine Oxgyenate ventilate Oro or nasotracheal intubation, maintain c- spine position If unable to intubate  surgical airway

19. Defnintive Airway: Immediate need: Maxillofacial trauma Protect c spine Oxgyenate and ventilate as needed If unable to intubate  surgical airway

20. Oxygenate and Ventilate Goal = achieve maximal cellular oxygen O2 at 10-12 L/min Tight fitting mask with resevoir Ventilate Avoid prolonged intubation attempts

21. Monitor Oxygenation Pulsoximeter –Measures oxygenated hemoglobin Utility –Difficult intubation –Transport Pa02 vs sat –90 = 100% –60 = 90% –30 – 60%

22. Oxygen – Hb dissociation curve

23. Questions on this section?

24. Summary Suspect airway compromise Protect C-spine Open airway and ventilate If in doubt  definitive airway Adequate oxygen delivery