Airway and ventilatory managment
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Airway and Ventilatory Managment. Objectives. Identify setting Regonize AWO Manage airway Define definitive airway. Coma Aspiration Facial trauma Neck trauma. Picture of bomb to face. Airway obstruction. Airway Obstruction Regonition. Look. Airway Obstruction Regonition. Listen.

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Airway and Ventilatory Managment

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Airway and ventilatory managment

Airway and Ventilatory Managment


Objectives

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


Airway obstruction regonition

Airway Obstruction Regonition

  • Look


Airway obstruction regonition1

Airway Obstruction Regonition

  • Listen


Airway obstruction regonition2

Airway Obstruction Regonition

  • Feel


Adequate breathing

Adequate Breathing

  • Provide oxygen

  • Subtle deterioration of breathing

  • Caution!

    • Coma

    • SCI

    • Chest trauma


Inadequate breathing

Look

Listen

Inadequate Breathing


Inadequate breathing1

Feel

Adjuncts

Inadequate Breathing


Adequate oxygenation

Adequate oxygenation

  • Requires

    • Oxygen

    • Definitive airway

    • Ventilation

  • Caution

    • Protect C-spine


Airway maintenance

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 Airway

Definitive aw = cuffed tube in trachea


Definitive airway1

Definitive Airway

  • Orotracheal

  • Nasotracheal

  • Surgical airway


Right bronchial intubation

Right Bronchial intubation

  • Xray of right bronchial intubation


Airway and ventilatory managment

RSI

  • Be prepared for surgical airway

  • Requires skill and training

  • Urgency must justify risk


Surgical airway

Surgical Airway

  • Indications

    • Inability to intubate the trachea

    • Maxillofacial trauma

    • Neck injury

  • Methods

    • Needle

    • Surgical


Defnintive airway immediate need apneic patient

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

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

Defnintive Airway:Immediate need:Maxillofacial trauma

  • Protect c spine

  • Oxgyenate and ventilate as needed

  • If unable to intubate  surgical airway


Oxygenate and ventilate

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%

Monitor Oxygenation


Oxygen hb dissociation curve

Oxygen – Hb dissociation curve


Questions on this section

Questions on this section?


Summary

Summary

  • Suspect airway compromise

  • Protect C-spine

  • Open airway and ventilate

  • If in doubt  definitive airway

  • Adequate oxygen delivery


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