![Page 1: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/1.jpg)
Author(s):PatrickCarter,DanielWachter,RockefellerOteng,CarlSeger,2009-2010.License:Unlessotherwisenoted,thismaterialismadeavailableunderthetermsoftheCreativeCommonsAttribution3.0License:http://creativecommons.org/licenses/by/3.0/
WehavereviewedthismaterialinaccordancewithU.S.CopyrightLawandhavetriedtomaximizeyourabilitytouse,share,andadaptit.Thecitationkeyonthefollowingslideprovidesinformationabouthowyoumayshareandadaptthismaterial.Copyrightholdersofcontentincludedinthismaterialshouldcontactopen.michigan@umich.eduwithanyquestions,corrections,orclarificationregardingtheuseofcontent.Formoreinformationabouthowtocitethesematerialsvisithttp://open.umich.edu/education/about/terms-of-use.Anymedicalinformationinthismaterialisintendedtoinformandeducateandisnotatoolforself-diagnosisorareplacementformedicalevaluation,advice,diagnosisortreatmentbyahealthcareprofessional.Pleasespeaktoyourphysicianifyouhavequestionsaboutyourmedicalcondition.Viewerdiscretionisadvised:Somemedicalcontentisgraphicandmaynotbesuitableforallviewers.
![Page 2: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/2.jpg)
CitationKeyformoreinformationsee:http://open.umich.edu/wiki/CitationPolicy
Use+Share+Adapt
MakeYourOwnAssessment
CreativeCommons–AttributionLicense
CreativeCommons–AttributionShareAlikeLicense
CreativeCommons–AttributionNoncommercialLicense
CreativeCommons–AttributionNoncommercialShareAlikeLicense
GNU–FreeDocumentationLicense
CreativeCommons–ZeroWaiver
PublicDomain–Ineligible:WorksthatareineligibleforcopyrightprotectionintheU.S.(USC17§102(b))*lawsinyourjurisdictionmaydiffer
PublicDomain–Expired:Worksthatarenolongerprotectedduetoanexpiredcopyrightterm.
PublicDomain–Government:WorksthatareproducedbytheU.S.Government.(USC17§105)
PublicDomain–SelfDedicated:Worksthatacopyrightholderhasdedicatedtothepublicdomain.
FairUse:UseofworksthatisdeterminedtobeFairconsistentwiththeU.S.CopyrightAct.(USC17 § 107)*lawsinyourjurisdictionmaydifferOurdeterminationDOESNOTmeanthatallusesofthis3rd-partycontentareFairUsesandweDONOTguaranteethatyouruseofthecontentisFair.Tousethiscontentyoushoulddoyourownindependentanalysis todeterminewhetherornotyourusewillbeFair.
{Contentthecopyrightholder,author,orlawpermitsyoutouse,shareandadapt.}
{ContentOpen.Michiganbelievescanbeused,shared,andadaptedbecauseitisineligibleforcopyright.}
{ContentOpen.MichiganhasusedunderaFairUsedetermination.}
![Page 3: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/3.jpg)
Advanced Emergency Trauma Course
GhanaEmergencyMedicineCollaborativePatrickCarter,MD∙DanielWachter,MD∙RockefellerOteng,MD∙CarlSeger,MD
AirwayandVentilatorManagement
Presenter:DanielWachter,MD
![Page 4: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/4.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Essentials of Emergency Airway Management
Knowtheanatomy. Learntheequipment. Learnthetechniques-10and20. Developjudgment.
![Page 5: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/5.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Compromise in Emergency Patients
CommonEtiologies:• Cardiacfailureandarrest• Respiratoryfailure(primary)• Neurologicaldiseases• Multipletrauma,headinjury,burns• Toxicologicalemergencies
![Page 6: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/6.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Indications for Emergency Airway Intervention
What are the indications?
Zen(flickr)
![Page 7: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/7.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Indications for Emergency Airway Intervention
Tocorrecthypoxemia(oxygenate)orhypercarbia(ventilate).
Toprovideapatent,secureairway. Tofacilitateotherinterventionsincriticallyillpatients(prophylactic).
Anticipateneedforintubationbasedonclinicalcourseandlikelihoodofdeterioration.
![Page 8: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/8.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Emergency Airway Management Options• Patencymaneuvers• Non-invasiveventilation• Endotrachealintubationwithorwithoutinductionandparalyticagents• Nasotrachealintubation• Adjunctairways• Surgicalairway
![Page 9: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/9.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
O2 Delivery Devices VenturiMask HudsonMask Nonrebreather NasalCannula
www.rcsed.ac.uk/ journal/vol46_5/fig-2.gif
![Page 10: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/10.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
O2 Delivery Devices BiPAP/CPAP
Source Undetermined Rarely works in critical airway cases – is patient DNI?
![Page 11: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/11.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
O2 Delivery Devices Endotrachealtube
Source Undetermined
![Page 12: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/12.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Patient Risk Factors for Airway Compromise Whyaretheseguysscaryairwaypatients?• Externalanatomy• AirwayAnatomy
SpoonyMushroom(flickr) http://commons.wikimedia.org/wiki/File:Glidescope_02.JPG
![Page 13: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/13.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
External Anatomy DifficultBag/MaskVentilation• Edentulous• Obese• HistoryofSnoring/SleepApnea• Beard• Age>55• Anatomicallyabnormalfacies• Facial/necktrauma• Obstructiveairwaydisease• 3rdtrimesterpregnancy
![Page 14: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/14.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
External Anatomy DifficultIntubation• Necktrauma• Prominentincisors• Recedingmandible• Cervicalspineimmobilization
Eg.bamboospine,fusion• Short,thinneck• Anatomicallyabnormalfacies• Morbidobesity
![Page 15: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/15.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Anatomy Mustknowtheanatomycold• Anatomicrelationship:
Tongue Vallecula Epiglottis VocalCords
Source Undetermined
![Page 16: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/16.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Review of Airway Anatomy
Nasopharynx Oropharynx Hypopharynx Larynx–Laryngoscopicview• Musthavethisburnedintoyourbraininordertobeanairwayexpert
![Page 17: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/17.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Anatomy
www.aap.org/nrp/ images/CDIMAGE4.JPG
www.medword.com/ pics/Anatomy/Fig956.gif
arytenoids & aryepiglottic folds
![Page 18: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/18.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Anatomy YouMUSTknowtheanatomy Maybedistorted……..
www.bgsm.edu/voice/ images www.bgsm.edu/voice/ images
![Page 19: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/19.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
http://www.childrensmemorial.org/cme/online/article.asp?articleID=179
http://www.childrensmemorial.org/cme/online/article.asp?articleID=179
![Page 20: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/20.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse Source Undetermined
![Page 21: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/21.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Assessment Decidingwhoneedsactiveairwaymanagement• Historyofpriordifficultyintubations• PhysicalExamFeatures
Obesity Shortneck Macroglossia Micrognathia Largeteeth SmallMouth
• ClinicalCondition Stablevs.Unstable ActiveBleeding Vomiting Needforprocedures OtherInterventions
![Page 22: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/22.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Physical Assessment of Airway Status
VitalSigns• RespiratoryRate,O2sat,BloodPressure,Heartrate
MentalStatus• Agitation,Somnolence,Coma
AirwayPatency• Secretions,Stridor,Obstruction,Edema
Ventilation• BreathSounds,AccessoryMuscleuse,Retractions,Rales,Wheezing
![Page 23: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/23.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Assessment Techniques MallampatiScore MouthOpening• 3fingersbetweenincisors
ThyromentalDistance• >6cm=“3fingers”• Predictslaryngoscopicgeometry
AdequateNeckExtension• Assumingnotrauma
Evaluateforobstruction
![Page 24: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/24.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Mallampati Classification
I 2
3 4http://www.bartleby.com/107/illus1201.html
![Page 25: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/25.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Management Techniques Patency Maneuvers
Fingersweepoforopharynx
Academy of Health Sciences, United States Army Medical Department
![Page 26: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/26.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Management Techniques Patency Maneuvers
Heimlichmaneuverorchestthrusts
Rama(Wikipedia)
![Page 27: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/27.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Management Techniques Patency Maneuvers
Headtiltwithchinlift,orjaw-thrustmaneuver
SourceUndetermined
![Page 28: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/28.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Management Techniques Patency Maneuvers
Suctioningofupperairway
www.anesth.uiowa.edu/
![Page 29: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/29.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Oral Airway
Preventstonguefromoccludingairway Requiresabsentgagreflex Canbeusedasabiteblock Placecarefullyoverthetongue Ifpatientcantolerateoralairway,theylikelyneedtobeintubated
![Page 30: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/30.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Nasal Airway Device
Pliable Goodforsonorouspatients Lubricatetip;placeinmostpatentnostril Gointheinferiorandmedialportionofthenostrilandhorizontaltothehardpalate
![Page 31: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/31.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Bag-Valve-Mask Ventilation Very important skill to know
May provide temporary or definitive airway management.
One person - importance of a good seal.
Two person technique more effective.
In EMS setting may be as useful as endotracheal intubation.
![Page 32: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/32.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Bag-Valve-Mask Ventilation
SourceUndetermined
![Page 33: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/33.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Oral Endotracheal Intubation The BASICS:
• Use of laryngoscope to provide visualization.
• Passage of a plastic air conduit through the vocal cords and into the trachea.
Very difficult (and inadvisable) to do without pharmacological aids • Except in patients who are in cardiorespiratory
arrest, deeply comatose, or neonates.
![Page 34: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/34.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Learn the equipment
SourceUndetermined SourceUndetermined
SourceUndeterminedSourceUndetermined
![Page 35: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/35.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Equipment and Preparation
Laryngoscope handle and blade
Endotracheal tube
Bag-Valve-Mask
Suction - large bore
Meds and good IV line
Monitor, O2 sat
![Page 36: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/36.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Laryngoscope Blades Miller Blade - (straight blade) -lifts the epiglottis. MacIntosh Blade (curved) - placed in vallecula
and tilts epiglottis anteriorly.
Kalumet(Wikipedia)Ignis(Wikipedia)
![Page 37: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/37.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Laryngoscope Blades AgeandBladeSizeandType:• PrematureInfant-0Miller• TermInfant-1Miller• UptoAge2-2MillerorMac• Olderchildren(age>12),smalladults-3MillerorMac• Largeradults-4MillerorMac
![Page 38: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/38.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Endotracheal Tube Sizing Premature - 2.5 mm
Term - 3.0 mm
Age 6 months - 3.5 mm
Age 1 year - 4.0 mm
Formula: 4 + age/4 = tube size
“Age 8 is enough for a cuff”
![Page 39: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/39.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Endotracheal Intubation The Mechanics
Adequate bed height and patient positioning.
Open mouth and remove dentures.
Hold blade in left hand!
Sweep tongue from right to left.
Avoid the teeth.
Airway can be externally manipulated by person holding cricoid pressure. BURP maneuver.
![Page 40: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/40.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Endotracheal Intubation The Mechanics
Position patient • Align oropharyngeal & laryngeal axis - Very important!
LarygealAxis
OropharyngealAxis
NationalCancerInstitute:Head&NeckOverview
![Page 41: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/41.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Endotracheal Intubation The Mechanics
Scissormouth BladeLhand
SourceUndetermined
![Page 42: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/42.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Endotracheal Intubation The Mechanics
Sweeptongue Avoidteeth
SourceUndetermined
![Page 43: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/43.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Endotracheal Intubation The Mechanics
Elevateepiglottis-liftinaxisoflaryngoscopehandle.
SourceUndetermined
http://www.cpp.usmc.mil/schools/fmss/_borders/intub8.jpg
![Page 44: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/44.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Endotracheal Intubation The Mechanics
Visualizevocalcords InsertETT SecureETT Withdrawstylet Inflatecuff Confirmplacement
Gray’sAnatomy(Wikipedia)
SourceUndetermined
![Page 45: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/45.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Endotracheal Intubation The Mechanics
KEY POINTS Position the patient correctly
When you see the cords, do not look away; have assistant give you everything you need.
Place the tube, remove stylet, inflate cuff.
Hold the tube until secured.
Tube depth in centimeters = Tube number x 3; or F - 21 cm, M - 23 cm at mouth corner.
![Page 46: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/46.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Rapid Sequence Induction (RSI) Endotracheal Intubation
Use of drugs to improve intubating conditions by eliminating patient resistance and providing muscular relaxation.
Co-administration of a potent sedative and a neuromuscular blocking agent.
Given in rapid sequence to decrease time of unprotected airway.
Assumes full stomach in emergency patient.
![Page 47: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/47.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Emergency Induction Agents Etomidate
0.2-0.3 mg/kg IV
Decreases intracranial pressure and intragastric pressure.
Minimal hemodynamic effects.
Can lead to adrenal suppression after one dose - unclear clinical significance.
![Page 48: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/48.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Emergency Induction Agents Ketamine
1-2 mg/kg IV Dissociative anesthetic, like PCP.
Catecholamine release leads to increased BP and HR and bronchodilation, increased secretions.
Good for asthma, bad for head injury or MI.
![Page 49: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/49.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
RSI Paralytics - Succinylcholine 1.5 - 2 mg/kg IV Fasciculation and skeletal muscle paralysis
within 45 seconds. Potential side effects
Bradyarrhythmias Increased IG, IO, and IC pressure Increased potassium Malignant hyperthermia Prolonged paralysis.
![Page 50: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/50.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Depolarizing – Binds to Nm receptor, opens Na channel causing depolarization.
Non-Depolarizing – Competes with Ach, does not activate Nm receptor
http://commons.wikimedia.org/wiki/File:Synapse_diag4.png
![Page 51: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/51.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
RSI Paralytics Non-Depolarizing Agents
E.g. Rocuronium 1 mg/kg IV Good choice if there is a clear
contraindication to succinylcholine. Non-depolarizing agents are usually
used to maintain paralysis rather than as RSI agents.
![Page 52: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/52.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
RSI Pretreatment Medications Lidocaine 1.5 mg/kg IV
Head injury and MI - recommended, not essential
Fentanyl 3 mcg/kg IV Head injury and MI. - recommended, not
essential.
Atropine 0.02 mg/kg IV for kids < 5 y/o Decrease succinlycholine-related bradycardia.
![Page 53: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/53.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
RSI - the Seven P’s Prepare t-10
Preoxygenate t-5
Pretreatment t-3
Paralysis after sedation
Protect - Sellick’s maneuver
Place tube
Post-intubation check
![Page 54: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/54.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Confirming Endotracheal Tube Placement
See tube go through cords. Watch for tube condensation.
Pulse oximetry and end tidal CO2 detector. Do not rely on capnometry in arrest/shock states
Auscultate stomach and lungs.
Chest X-ray for tube positioning in trachea.
![Page 55: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/55.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Emergency Airway Success Rates Method Intubations (%) Success Rate
RSI 67 99%
Oral, sedation 7 92%
Oral, no meds 18 93%
Nasotracheal 7 86%
from the NEAR II study (National Emergency Airway Registry)
![Page 56: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/56.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Alternatives to Standard Endotracheal Intubation
Nasotracheal intubation
Intubating laryngeal mask airway (LMA)
Transtracheal Jet Ventilation (TTJV)
Others Retrograde, Digital, Lighted stylet, Fiberoptic-assisted.
Cricothyrotomy or Tracheostomy
ALL require advanced/additional training
![Page 57: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/57.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Nasotracheal Intubation Pt. cooperative and upright.
Good for oxygenation and ventilation problems - CHF, asthma, COPD
Anesthetize nose, lubricate tube, use tube 0.5 - 1 mm smaller than for oral use
Most patent nare, go medial and inferior, listen, advance - timing and rhythm are key.
![Page 58: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/58.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Nasotracheal Intubation
faculty.washington.edu/pcolley/
http://commons.wikimedia.org/wiki/File:Chapter5figure69b-nasotracheal_intubation.jpg
![Page 59: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/59.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Cricothyrotomy - Indications
Definitiveairwaycontrolwhennonsurgicalmethodsfail.
Upperairwayobstructionduetotrauma,edema,foreignbody,infection.
Source Undetermined
![Page 60: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/60.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Cricothyrotomy Relative Contraindications
Age < 8 years old Bleeding disorder
Infections of neck or airway
Transection of airway
![Page 61: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/61.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Cricothyrotomy - Procedure Locate cricothyroid membrane.
Vertical skin incision 3-4 cm.
Stabilize thyroid cartilage with hand or hook.
Horizontal incision through inferior portion of membrane.
Insert instrument to widen hole.
Place tube, inflate cuff, secure.
![Page 62: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/62.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Cricothyrotomy - Procedure
www.theairwaysite.com
www.theairwaysite.com
www.theairwaysite.com
![Page 63: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/63.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Cricothyrotomy: Complications Early
Bleeding
Trauma to adjacent structures
Tube misplacement.
Later Infection
Subglottic stenosis.
Loss of the airway.
![Page 64: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/64.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Pediatric Airway Management Airway smaller.
U-shaped floppy epiglottis.
Larynx more anterior and cephalad.
Narrowest point is cricoid cartilage.
![Page 65: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/65.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Pediatric Airway Management Use Broselow-Luten tape.
“At age 2, #2 (Mac or Miller).
“Below age 5, atropinize.”
“8 is enough for cut and cuff.”
![Page 66: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/66.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Management Case #1 Analcohol-intoxicatedmanhadaseizureinthepark.
Vitalsigns:• 140/100,P120,R18,Pulseox-93%,roomair.
Exam:Nosignsoftrauma;intactgagreflex;maceratedtongue;sonorousrespirations;clearlungs;non-focalneuroexam.
Whatistheappropriateairwaymanagement?
![Page 67: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/67.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Emergency Airway Management
Options• Patencymaneuvers• Non-invasiveventilation• Endotrachealintubationwithorwithoutinductionandparalyticagents• Nasotrachealintubation• Surgicalairway
![Page 68: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/68.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Management Case #2 78y.o.male,historyofMI,awakensSOB.BroughtbywifetoED.
Vitalsigns:• 210/120,P120,R32,Pulseox-88%,roomair.
Exam:• Diaphoretic,restless,confused,dusky,lungsverywet,positiveJVD.S3present.
Whatistheappropriateairwaymanagement?
![Page 69: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/69.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Emergency Airway Management
Options• Patencymaneuvers• Non-invasiveventilation• Endotrachealintubationwithorwithoutinductionandparalyticagents• Nasotrachealintubation• Surgicalairway
![Page 70: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/70.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Management Case #3 A36y.o.womanisbroughttoEDbyherhusbandafteringesting90Elaviltablets,“Downers”,Paxiltablets,andEtOHinasuicideattempt.
Vitalsigns:• 90/60,P136,R16,Pulseox-96%,roomair.
Exam:Uncooperative,somewhatdrowsy,hyperreflexic,lungsclear.
Whatistheappropriateairwaymanagement?
![Page 71: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/71.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Emergency Airway Management
Options• Patencymaneuvers• Non-invasiveventilation• Endotrachealintubationwithorwithoutinductionandparalyticagents• Nasotrachealintubation• Surgicalairway
![Page 72: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/72.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Airway Management Case #4 A3y.o.girlwasrunningwithasharptoyinhermouthandfell.Sustainedoropharyngealtrauma.
Vitalsigns:• 90/65,P145,R36,Pulseox-89%,roomair.
Exam:• Crying,child,somewhatcyanotic,drooling,hasstridor,obvioussubmentaledema.Tracheamidline.
Whatistheappropriateairwaymanagement?
![Page 73: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/73.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Emergency Airway Management
Options• Patencymaneuvers• Non-invasiveventilation• Endotrachealintubationwithorwithoutinductionandparalyticagents• Nasotrachealintubation• Surgicalairway
![Page 74: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/74.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Special thanks to Richard Taylor, MD Brian Zink, MD
For developing slides and content For the UM ED M4 Airway Lecture
![Page 75: Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl … · 2015-04-22 · Vital Signs ... Head & Neck Overview Ghana ... unclear clinical significance](https://reader033.vdocument.in/reader033/viewer/2022050109/5f476404a41e193e4a7cdf4a/html5/thumbnails/75.jpg)
GhanaEmergencyMedicineCollaborativeAdvancedEmergencyTraumaCourse
Questions?
Dkscully(flickr)