1. Instructor 張志華 Airway in Trauma

2. Instructor 張志華 Indications n Control IICP –PaCO2 : 25-30 mmHg n Respiratory failure –CPR, flail chest, severe shock n Obtain airway –Potential of airway compromise (e.g. gunshot) n Protect airway –Aspiration risk, thermal / caustic airway burn

3. Instructor 張志華 Orotracheal Intubation n C-spine immobilization –In-line stabilization –Do not apply traction n Technique –Rapid sequence intubation (RSI) –Sedation-aided intubation (SAI)

4. Instructor 張志華 Orotracheal Intubation Difficult Intubation : –Short muscular neck –Mentum-hyoid distance < 3 f.b. –Open mouth < 3 cm

5. Instructor 張志華 Rapid Sequence Intubation n Prepare : Equipment n Preoxygenation : 100% 3-5min n Premedications (3min) : –Lidocaine 1.5 mg/kg –Pancuronium 0.01 mg/kg –Atropine 0.02 mg/kg (if < 5 yr) –Thiopental 3-5 mg/kg n Paralysis : Succinylcholine 1.5 mg/kg n Pass the tube

6. Instructor 張志華 Succinylcholine n Succinylcholine –Dose 1.5 mg/kg –Onset 30-60 sec; duration 4-6 min n Contrindications –Open globe injuries –Burns, crush injuries, or paralysis over 48 hr and under 6 wk old (cause hyperkalemia) –IICP without pretreatment (lidocaine, defasciculating agent, sedative)

7. Instructor 張志華 Sellick Maneauver n Method : –Cricoid pressure n Indication : –Prevent regurgitation and aspiration n To apply : –Just after the administration of succinylcholine n To release : –After successful intubation and ET cuff inflated

8. Instructor 張志華 Ketamine n Pharmacokinetic : –Dose 2 mg/kg; onset 60 sec; duration 15 min n Advantages : –Less respiratory depression –Intact protective airway reflexes –Does not lower BP –Bronchodilator (best choice in status asthmaticus) n Contraindication : IICP

9. Instructor 張志華 Nasotracheal Intubation n Contraindications : –Apnea –Severe maxillofacial trauma –Basilar skull fracture –Coagulopathy (coumadin, cirrhosis, hemophilia) –IICP without pretreament (lidocaine, sedative)

10. Instructor 張志華 Cricothyroidotomy n Contraindications : –Age < 12 yr u Consider needle cricothyroidotomy + jet ventilation (30- 45min) followed by tracheostomy –Laryngeal pathology (tumor, fracture, hematoma) u Consider needle tracheotomy above sternal notch + jet ventilation (30- 45min) followed by tracheostomy –Tracheal transection

11. Instructor 張志華 Pediatric Intubation n Sniffing position –Without padding the occiput n Straight blade –Stiffer and shorter epiglottis n Uncuffed ET tubes –If < 10 yr; smallest diameter at cricoid ring n Tube size –4 + age/4; child’s little finger