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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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Presentation Transcript
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
adequate breathing
Adequate Breathing
  • Provide oxygen
  • Subtle deterioration of breathing
  • Caution!
    • Coma
    • SCI
    • Chest trauma
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
slide15
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
summary
Summary
  • Suspect airway compromise
  • Protect C-spine
  • Open airway and ventilate
  • If in doubt  definitive airway
  • Adequate oxygen delivery