Download - Managemen Airway
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Airway and Ventilatory Management
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Objectives Indentify when airway compromise will occur. Recognize acute airway obstruction Describe techniques to establish and maintain
Patent airway Define definitive airway with c-spine
Protection Demonstrate ventilatory technicques.
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Airway Obstruction Recognition
Listen Normal speech → No obstruction Noisy breathing → Obstruction
• Gurgle • Stridor • Hoarseness
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Airway Obstruction Coma Aspiration Maxillofacial
trauma Neck trauma
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Airway Obstruction Recognition
Look Aglitation / obtunded ↓Air movement Retraction /”rocking” respirations Deformity Airway debris
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Adequate Breathing
Provide supplemental oxygen Subtle deterioration of breathing
• Coma • Spinal cord injury • Direct chest traumaCaution
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Airway Obstruction Recognition
Feel Maxillofacial/ laryngeal crepitus Tracheal deviation Hematoma
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Inadequate Breathing
Look Cyanosis ∆ in mental status Chest asymmetry Tachypnea Neck vein distention Paralysis
Listen “I can ‘t breathe !” Stridor , wheezes ↓Or Absent breath
sounds
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Inadequate Breathing
Feel Subg emphysema Chest wall
crepitus / tenderness Tracheal deviation
Adjuncts Pulse oximeter CO₂ detector ABGs Chest X- Ray
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Adequate OxygenationRequires Supplemental O₂ Airway Maintenance techniques or
definitive airway Ventilation
Protect c-spineCaution
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Airway Maintenance
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Definitive AirwayNeed for Airway Coma Maxillofacial injury Aspiration Airway injury
Definitive = Airway
Need For breathing Apnea Hypoxia Hypercarbia Brain Injury
Tube In trachea with cuff inflated
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Definitive Airway
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Right Bronchial Intubation
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Rapid Sequence Intubation Be Prepared for surgical airway Requires skill and training
Urgency must justify risk !
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Surgical Airway Indications: Inability to intubate trachea • Maxilofacial Trauma • Neck injury Methods • Needle cricothyroidotomy with jet
insufflation • Surgical cricothyroidotomy
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Definitive AirwayImmediate Need : Apneic Patient Suspect c-spine injury Ogxygenate and ventilate Oroctarcheal intubation, protect c-spine If unable to intubate → Surgical airway
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Definitive AirwayImmediate Need: Breathing Patient Suspect c-spine injury Oxygenate and ventilate as needed Oro- or nasotracheal intubation protect
c-spine If unable to intubate → surgical airway
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Definitive AirwayImmedieate Need : Maxillofacial Trauma Suspect C-spine injury Oxygenate and ventilate as needed If unable to intubate → surgical airway
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Oxygenate and Ventilate
Goal: Achieve Maximal cellular O₂ O₂ at 10-12 liters / minute Tight-fitting oxygen reservoir mask Ventilate Avoid prolonged attempts at intubation
without oxygenation
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Monitor Oxygenation
Pulse Oximeter
Measures O₂ hemoglobin sat
Untility• Difficult intubation • During transport
PaO₂ O₂ Hgb Sat
90 mm Hg 100%60 mm Hg 90%30 mm Hg 60%27 mm Hg 50%
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O₂/ Hgb Dissociation Cure
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Questions
?
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Summary Suspect airway compromise Protect C- spine Open airway and ventilate If in doubt → Definitive airway
• Urgency of need • Clinical judgment and skill
Adequate O₂ delivery