Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle...

Campbell, International Trauma Life Support, 6th Ed.© 2008 Pearson Education, Inc., Upper Saddle River, NJ

International Trauma Life Support

International Trauma Life Support

for Prehospital Care ProvidersSixth Edition

for Prehospital Care ProvidersSixth Edition

Patricia M. Hicks, MS, NREMTPRoy Alson, PhD, MD, FACEP

Donna Hastings, EMT-PJohn Emory Campbell, MD, FACEP

and Alabama Chapter,American College of Emergency Physicians

Patricia M. Hicks, MS, NREMTPRoy Alson, PhD, MD, FACEP

Donna Hastings, EMT-PJohn Emory Campbell, MD, FACEP

and Alabama Chapter,American College of Emergency Physicians

Chapter 4Initial Airway ManagementChapter 4Initial Airway Management


Initial Airway Management


OverviewRespiratory anatomy and physiology

Importance of observation

Supplemental oxygen, various airway adjuncts• Indications, contraindications, advantages,

disadvantages

Predictors of difficulty• Mask ventilation and endotracheal intubation

Sellick maneuver

Essential components of airway kit3Airway -


Initial Airway Management

Most important trauma care task

• Challenging in field

• Frequently time critical

• Unpredictable

• Need options and alternatives

• Always start with basics

4Airway -


Anatomy and Physiology

5Airway -



6Airway -

Nasopharynx• Delicate• Turbinates

Oropharynx• Hyoid bone

Hypopharynx• Epiglottis



7Airway -

Larynx

• Laryngeal prominence

• Vocal cords

• Thyroid cartilage

• Cricoid cartilage• Sellick maneuver

• Cricothyroid membrane



Trachea, bronchi• Carina• Mainstem bronchi• Protective reflexes

Lungs• Pleural space• Alveolocapillary membrane

8Airway -


Average Adult

Distances can vary by several cm.

2–2.5 cm movement in flexion/extension

9Airway -


Patent Airway

Airway - 10

Without a patent airway,

all other care is of little use.

Without a patent airway,

all other care is of little use.


Patent Airway

Continual observation

Suction with large-bore tubing

Airway adjuncts

• Nasopharyngeal airway

• Oropharyngeal airway

• Blind insertion airway device (BIAD)

• Endotracheal intubation

11Airway -


Difficult Airway

Rapid sequence intubation (RSI)• BVM ventilation and immediate transport

Assessment of difficult airway• Remember MMAP

• M Mallampati

• M Measurement 3-3-1

• A Atlanto-occipital extension

• P Pathology

12Airway -


MMAP: Mallampati Score

13Airway -


MMAP

Measurement 3-3-1• Chin to hyoid bone• Opening of mouth• Lower-jaw protrusion

Atlanto-occipital extension

• Only if cervical-spine injury not suspected

Pathology

• Anatomic airway obstructions

14Airway -


Patent Airway

Airway - 15

Noisy breathing

is obstructed breathing.

Noisy breathing

is obstructed breathing.


Normal Perfusion

Normal oxygenation• PaO2: 100 mmHg

Pulse oximetry• Goal: maintain SpO2 >95%

• Monitor SpO2 with all trauma patients

• Monitor SpO2 with any respiratory compromise

16Airway -


Supplemental Oxygen

% Oxygen Device Flow Rate

40–50% Simple Face Mask 10–12 lpm

60–90% NRB Face Mask 12–15 lpm

25–30% Nasal Cannula 2–6 lpm

40–50% BVM 12–15 lpm

90–100% BVM with Reservoir Bag 12–15 lpm

100% FRPPVD 40 lpm

17Airway -


Normal Ventilation

18Airway -


Normal Ventilation

Normal ventilation• Carbon dioxide in blood (pCO2) 35–40 mmHg

Abnormal ventilation• Hypoventilation: pCO2 above 40 mmHg

• Hyperventilation: pCO2 below 35 mmHg

Capnography• End-tidal CO2 (EtCO2) relates directly to pCO2

19Airway -


20Airway -

When in doubt,

give oxygen!

When in doubt,

give oxygen!


Positive Pressure

Ventilation rate• 10–12 per minute Non-intubated

patient• 8–10 per minute Intubated patient

Supplemental oxygen essential

Suction must be immediately available• Avoid gastric distention

Monitor lung compliance21Airway -


Perfusion and Ventilation

22

• Pulse oximetry (SpO2)monitors oxygenation

Monitor effectiveness

Airway -

• Capnography (EtCO2)monitors ventilation


B Beards

O Obesity

O Older patients

T Toothlessness

S Snores or stridor

23Airway -

Difficult BVM Ventilation


Airway Kit

Airway adjuncts• Various adjuncts• Intubation kit• Rescue airway device

Portable suction

Monitoring devices• SpO2

• EtCO2

Oxygen cylinder

Oxygen delivery • Cannula and masks• Pocket mask• BVM with reservoir bag

24Airway -


Summary

Ensuring a patent airway is essential.

• Need a clear understanding of anatomy, tidal volume, minute volume, compliance.

• Must be proficient in various techniques.

• Equipment must be immediately available.

When in doubt—give oxygen!

25Airway -


Discussion

26Airway -


• Click for Next Chapter

Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle...

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Transcript of Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle...