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Airway and Ventilatory Management

Airway and Ventilatory Management. Chapter 2. Objectives. Ensure adequacy of the airway Confirm adequacy of ventilation Define “definitive airway” Maintain adequate oxygenation in all phases of airway management. Key Questions. How do I know the airway is adequate?

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Airway and Ventilatory Management

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  1. Airway and Ventilatory Management Chapter 2

  2. Objectives • Ensure adequacy of the airway • Confirm adequacy of ventilation • Define “definitive airway” • Maintain adequate oxygenation in all phases of airway management

  3. Key Questions • How do I know the airway is adequate? • How do I know ventilation is adequate? • How do I know oxygenation is adequate? • What are the pitfalls?

  4. What if… • …the patient talks clearly? • Management: observation and selective intubation • High index of suspicion with: • Maxillofacial injuries • Soft-tissue injury of neck • Facial or neck burns

  5. What if… • …the patient is hoarse? • Possible: • Laryngeal injury • Laryngeal/tracheal burn • Management: Evaluate and perform • Careful endoscopic exam • Careful and gentle intubation • Surgical airway?

  6. What if… • …the patient cannot respond? • GCS score <9 • Obstruction due to: • Tongue • Aspiration • Foreign body • Maxillofacial injury • Neck injury

  7. What if… • …patient cannot respond? • Cyanosis, decerased or no air exchange, facial/cervical crepitus, neck hematoma • Simple management maneuvers: • Suction • Chin lift/jaw thrust • Definitive airway: cuffed tube in trachea

  8. After adjunct • Assess for signs of obstruction • Confirm correct ET tube position • Auscultate in medial axillae • Assess oxygenation • Assess ventilation (CO2 detector) • Obtain chest X-ray

  9. Protect the cervical spine during airway management!

  10. Key questions • How do I know ventilation is adequate? • What do I see? • What do I feel? • What do I hear? • What do I measure? • What might I find? • How do I manage the patient?

  11. What do I see? • Respiratory rate and effort • Respiratory distress/labored breathing • Cyanosis • Restlessness/anxiety • Chest asymmetry/paradoxical breathing

  12. What do I feel? • Crepitance • Local tenderness • Asymmetric respiratory excursion

  13. What do I hear? • Noisy breathing • Asymmetric breath sounds • Absent breath sounds

  14. What do I measure? • Mental status • Vital signs • Pulse oximetry • End-tidal CO2 • ABGs

  15. What might I find? • Tension pneumothorax • Pneumothorax • Hemopneumothorax • Malposiitoned ET tube • Neurological deficit • Direct neck/chest injury

  16. How do I manage the patient? • Establish appropriate airway • Administer supplemental oxygen • Decompress the chest • Reposition the ET tube • Provide mechanical ventilation • Perform a surgical airway

  17. Ventilation adequate? • Mental status evaluation • Vital signs • Pulse oximetry • ABGs

  18. What are the pitfalls? • Airway versus ventilation • RSI (rapid sequence intubation) – inability to intubate • Dislodged/malpositioned ET tube • Aspiration • Equipment failure

  19. Summary • How do I know the airway is adequate? • How do I know ventilation is adequate? • How do I know oxygenation is adequate? • What are the pitfalls?

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