Airway and Ventilatory Managment

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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 to face

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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 AirwayImmediate needApneic 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 AirwayImmediate needBreathing
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 AirwayImmediate needMaxillofacial
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