airway and ventilatory managment. objectives identify setting regonize awo manage airway define...
TRANSCRIPT
Airway and Ventilatory Managment
Objectives
• Identify setting
• Regonize AWO
• Manage airway
• Define definitive airway
Airway obstruction
• Coma• Aspiration• Facial trauma• Neck trauma
• Picture of bomb to face
Airway Obstruction Regonition
• Look
Airway Obstruction Regonition
• Listen
Airway Obstruction Regonition
• Feel
Adequate Breathing
• Provide oxygen
• Subtle deterioration of breathing
• Caution!– Coma– SCI– Chest trauma
Inadequate Breathing
• Look • Listen
Inadequate Breathing
• Feel • Adjuncts
Adequate oxygenation
• Requires– Oxygen– Definitive airway– Ventilation
• Caution– Protect C-spine
Airway Maintenance
• Chin lift
• Jaw thrust
• Oral airway
• Nasal airway
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
Definitive Airway
• Orotracheal
• Nasotracheal
• Surgical airway
Right Bronchial intubation
• Xray of right bronchial intubation
RSI
• Be prepared for surgical airway
• Requires skill and training
• Urgency must justify risk
Surgical Airway
• Indications– Inability to intubate the trachea– Maxillofacial trauma– Neck injury
• Methods– Needle– Surgical
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
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
Defnintive Airway:Immediate need:
Maxillofacial trauma
• Protect c spine
• Oxgyenate and ventilate as needed
• If unable to intubate surgical airway
Oxygenate and Ventilate
• Goal = achieve maximal cellular oxygen
• O2 at 10-12 L/min
• Tight fitting mask with resevoir
• Ventilate
• Avoid prolonged intubation attempts
Monitor Oxygenation
• Pulsoximeter– Measures oxygenated
hemoglobin
• Utility– Difficult intubation
– Transport
• Pa02 vs sat– 90 = 100%
– 60 = 90%
– 30 – 60%
Oxygen – Hb dissociation curve
Questions on this section?
Summary
• Suspect airway compromise
• Protect C-spine
• Open airway and ventilate
• If in doubt definitive airway
• Adequate oxygen delivery