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Airway and Ventilatory

Managment

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Objectives

Identify setting Regonize AWO Manage airway Define definitive airway

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Airway obstruction

Coma Aspiration Facial trauma Neck trauma

Picture of bomb toface

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Airway Obstruction Regonition

Look

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Airway Obstruction Regonition

Listen

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Airway Obstruction Regonition

Feel

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Adequate Breathing

Provide oxygen Subtle deterioration of breathing Caution!

Coma SCI Chest trauma

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Inadequate Breathing

Look Listen

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Inadequate Breathing

Feel Adjuncts

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Adequate oxygenation

Requires Oxygen Definitive airway Ventilation

Caution Protect C-spine

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Airway Maintenance

Chin lift Jaw thrust Oral airway Nasal airway

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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

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Definitive Airway

Orotracheal Nasotracheal Surgical airway

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Right Bronchial intubation

Xray of right bronchial intubation

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RSI

Be prepared for surgical airway Requires skill and training Urgency must justify risk

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Surgical Airway

Indications Inability to intubate the trachea Maxillofacial trauma Neck injury

Methods Needle Surgical

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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

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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

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Defnintive Airway:Immediate need:

Maxillofacial trauma

Protect c spine Oxgyenate and ventilate as needed If unable to intubate surgical airway

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Oxygenate and Ventilate

Goal = achieve maximal cellular oxygen O2 at 10-12 L/min Tight fitting mask with resevoir Ventilate Avoid prolonged intubation attempts

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Monitor Oxygenation

Pulsoximeter Measures oxygenated

hemoglobin Utility

Difficult intubation Transport

Pa02 vs sat 90 = 100%

60 = 90% 30 60%

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Oxygen Hb dissociation curve

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Questions on this section?

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Summary

Suspect airway compromise Protect C-spine Open airway and ventilate If in doubt definitive airway Adequate oxygen delivery