Airway and Ventilatory Managment. Objectives Identify setting Regonize AWO Manage airway Define definitive airway.

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Presentation transcript:

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

Inadequate Breathing LookListen

Inadequate Breathing FeelAdjuncts

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 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