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

• Look Inadequate Breathing • Listen

• Feel Inadequate Breathing • 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