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