Chapter 2

 Ensure adequacy of the airway  Confirm adequacy of ventilation  Define “definitive airway”  Maintain adequate oxygenation in all phases of airway management

 How do I know the airway is adequate?  How do I know ventilation is adequate?  How do I know oxygenation is adequate?  What are the pitfalls?

 …the patient talks clearly?  Management: observation and selective intubation  High index of suspicion with: ◦ Maxillofacial injuries ◦ Soft-tissue injury of neck ◦ Facial or neck burns

 …the patient is hoarse?  Possible: ◦ Laryngeal injury ◦ Laryngeal/tracheal burn  Management: Evaluate and perform ◦ Careful endoscopic exam ◦ Careful and gentle intubation ◦ Surgical airway?

 …the patient cannot respond?  GCS score <9  Obstruction due to: ◦ Tongue ◦ Aspiration ◦ Foreign body ◦ Maxillofacial injury ◦ Neck injury

 …patient cannot respond?  Cyanosis, decerased or no air exchange, facial/cervical crepitus, neck hematoma  Simple management maneuvers: ◦ Suction ◦ Chin lift/jaw thrust ◦ Definitive airway: cuffed tube in trachea

 Assess for signs of obstruction  Confirm correct ET tube position  Auscultate in medial axillae  Assess oxygenation  Assess ventilation (CO 2 detector)  Obtain chest X-ray

 Protect the cervical spine during airway management!

 How do I know ventilation is adequate? ◦ What do I see? ◦ What do I feel? ◦ What do I hear? ◦ What do I measure? ◦ What might I find? ◦ How do I manage the patient?

 Respiratory rate and effort  Respiratory distress/labored breathing  Cyanosis  Restlessness/anxiety  Chest asymmetry/paradoxical breathing

 Crepitance  Local tenderness  Asymmetric respiratory excursion

 Noisy breathing  Asymmetric breath sounds  Absent breath sounds

 Mental status  Vital signs  Pulse oximetry  End-tidal CO 2  ABGs

 Tension pneumothorax  Pneumothorax  Hemopneumothorax  Malposiitoned ET tube  Neurological deficit  Direct neck/chest injury

 Establish appropriate airway  Administer supplemental oxygen  Decompress the chest  Reposition the ET tube  Provide mechanical ventilation  Perform a surgical airway

 Mental status evaluation  Vital signs  Pulse oximetry  ABGs

 Airway versus ventilation  RSI (rapid sequence intubation) – inability to intubate  Dislodged/malpositioned ET tube  Aspiration  Equipment failure

 How do I know the airway is adequate?  How do I know ventilation is adequate?  How do I know oxygenation is adequate?  What are the pitfalls?