Transcript ATLS: Airway

Instructor 張志華
Airway in Trauma
Indications
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Control IICP
– PaCO2 : 25-30 mmHg
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Respiratory failure
– CPR, flail chest, severe shock
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Obtain airway
– Potential of airway compromise (e.g. gunshot)
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Protect airway
– Aspiration risk, thermal / caustic airway burn
Instructor 張志華
Orotracheal Intubation
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C-spine immobilization
– In-line stabilization
– Do not apply traction
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Technique
– Rapid sequence intubation (RSI)
– Sedation-aided intubation (SAI)
Instructor 張志華
Orotracheal Intubation
Difficult Intubation :
– Short muscular neck
– Mentum-hyoid distance < 3 f.b.
– Open mouth < 3 cm
Instructor 張志華
Rapid Sequence Intubation
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Prepare : Equipment
Preoxygenation : 100% 3-5min
Premedications (3min) :
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Lidocaine 1.5 mg/kg
Pancuronium 0.01 mg/kg
Atropine 0.02 mg/kg (if < 5 yr)
Thiopental 3-5 mg/kg
Paralysis : Succinylcholine 1.5 mg/kg
Pass the tube
Instructor 張志華
Succinylcholine
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Succinylcholine
– Dose 1.5 mg/kg
– Onset 30-60 sec; duration 4-6 min
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Contrindications
– Open globe injuries
– Burns, crush injuries, or paralysis over 48 hr and under
6 wk old (cause hyperkalemia)
– IICP without pretreatment (lidocaine, defasciculating
agent, sedative)
Instructor 張志華
Sellick Maneauver
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Method :
– Cricoid pressure
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Indication :
– Prevent regurgitation and aspiration
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To apply :
– Just after the administration of succinylcholine
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To release :
– After successful intubation and ET cuff inflated
Instructor 張志華
Ketamine
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Pharmacokinetic :
– Dose 2 mg/kg; onset 60 sec; duration 15 min
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Advantages :
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Less respiratory depression
Intact protective airway reflexes
Does not lower BP
Bronchodilator (best choice in status asthmaticus)
Contraindication : IICP
Instructor 張志華
Nasotracheal Intubation
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Contraindications :
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Apnea
Severe maxillofacial trauma
Basilar skull fracture
Coagulopathy (coumadin, cirrhosis, hemophilia)
IICP without pretreament (lidocaine, sedative)
Instructor 張志華
Cricothyroidotomy
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Contraindications :
– Age < 12 yr
 Consider
needle cricothyroidotomy + jet ventilation
(30- 45min) followed by tracheostomy
– Laryngeal pathology (tumor, fracture, hematoma)
 Consider
needle tracheotomy above sternal notch +
jet ventilation (30- 45min) followed by tracheostomy
– Tracheal transection
Instructor 張志華
Pediatric Intubation
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Sniffing position
– Without padding the occiput
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Straight blade
– Stiffer and shorter epiglottis
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Uncuffed ET tubes
– If < 10 yr; smallest diameter at cricoid ring
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Tube size
– 4 + age/4; child’s little finger
Instructor 張志華