Goal: Maintain EtCO2 of 35 mmHg. Capnography also indirectly - PowerPoint PPT Presentation

1 / 26
About This Presentation
Title:

Goal: Maintain EtCO2 of 35 mmHg. Capnography also indirectly

Description:

Goal: Maintain EtCO2 of 35 mmHg. Capnography also indirectly measures metabolism and circulation. Before exhalation, blood carries CO2 from cells to lungs. – PowerPoint PPT presentation

Number of Views:95
Avg rating:3.0/5.0
Slides: 27
Provided by: abcmeduca
Category:

less

Transcript and Presenter's Notes

Title: Goal: Maintain EtCO2 of 35 mmHg. Capnography also indirectly


1
Chapter 4 Initial Airway Management
2
Initial Airway Management
3
Overview
  • Respiratory 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 kit

4
Initial Airway Management
  • Most important trauma care task
  • Challenging in field
  • Frequently time critical
  • Unpredictable
  • Need options and alternatives
  • Always start with basics

5
Anatomy and Physiology
6
Anatomy and Physiology
  • Nasopharynx
  • Delicate
  • Turbinates
  • Oropharynx
  • Hyoid bone
  • Hypopharynx
  • Epiglottis

7
Anatomy and Physiology
  • Larynx
  • Laryngeal prominence
  • Vocal cords
  • Thyroid cartilage
  • Cricoid cartilage
  • Sellick maneuver
  • Cricothyroid membrane

8
Anatomy and Physiology
  • Trachea, bronchi
  • Carina
  • Mainstem bronchi
  • Protective reflexes
  • Lungs
  • Pleural space
  • Alveolocapillary membrane

9
Average Adult
  • Distances can vary by several cm.
  • 22.5 cm movement in flexion/extension

10
Patent Airway
  • Without a patent airway,
  • all other care is of little use.

11
Patent Airway
  • Continual observation
  • Suction with large-bore tubing
  • Airway adjuncts
  • Nasopharyngeal airway
  • Oropharyngeal airway
  • Blind insertion airway device (BIAD)
  • Endotracheal intubation

12
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

13
MMAP Mallampati Score
14
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

15
Patent Airway
  • Noisy breathing
  • is obstructed breathing.

16
Normal Perfusion
  • Normal oxygenation
  • PaO2 100 mmHg
  • Pulse oximetry
  • Goal maintain SpO2 gt95
  • Monitor SpO2 with all trauma patients
  • Monitor SpO2 with any respiratory compromise

17
Supplemental Oxygen
18
Normal Ventilation
  • Tidal volume (VT)
  • Amount moved with each breath
  • 400 to 600cc (adult)
  • VT x breaths/minute Minute volume
  • 500cc x 12 breaths/min 6 liters/min (adult)
  • Fast, shallow 250cc x 24 breaths/min 6
    liters/min
  • Slow, deep 750cc x 8 breaths/min 6 liters/min

19
Normal Ventilation
  • Normal ventilation
  • Carbon dioxide in blood (pCO2) 3540 mmHg
  • Abnormal ventilation
  • Hypoventilation pCO2 above 40 mmHg
  • Hyperventilation pCO2 below 35 mmHg
  • Capnography
  • End-tidal CO2 (EtCO2) relates directly to pCO2

20
  • When in doubt,
  • give oxygen!

21
Positive Pressure
  • Ventilation rate
  • 1012 per minute Non-intubated patient
  • 810 per minute Intubated patient
  • Supplemental oxygen essential
  • Suction must be immediately available
  • Avoid gastric distention
  • Monitor lung compliance

22
Perfusion and Ventilation
  • Monitor effectiveness
  • Pulse oximetry (SpO2)monitors oxygenation
  • Capnography (EtCO2)monitors ventilation

23
Difficult BVM Ventilation
  • B Beards
  • O Obesity
  • O Older patients
  • T Toothlessness
  • S Snores or stridor

24
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

25
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 doubtgive oxygen!

26
Discussion
Write a Comment
User Comments (0)
About PowerShow.com