1 © ACS Airway and Ventilatory Management
© ACS2
Objectives
Identify when airway compromise will occur Recognize acute airway obstruction Describe techniques to establish and maintain
patent airway Define definitive airway with c-spine
protection Demonstrate ventilatory techniques
© ACS4
Airway Obstruction Recognition
Look Agitation / obtunded Air movement Retraction /”rocking” respirations Deformity Airway debris
© ACS5
Airway Obstruction Recognition
Listen Normal speech → No obstruction Noisy breathing → Obstruction
• Gurgle
• Stridor
• Hoarseness
© ACS6
Airway Obstruction Recognition
Feel Maxillofacial / laryngeal crepitus
fractures Tracheal deviation Hematoma
© ACS7
Adequate Breathing
Provide supplemental oxygen Subtle deterioration of breathing
• Coma • Spinal cord injury • Direct chest traumaCaution
© ACS8
Inadequate Breathing
Look Cyanosis in mental status Chest asymmetry Tachypnea Neck vein
distention Paralysis
Listen “I can‘t breathe !” Stridor, wheezes or absent breath
sounds
© ACS9
Inadequate Breathing
Feel Subq. emphysema Chest wall
crepitus / tenderness Tracheal deviation
Adjuncts Pulse oximeter CO2 detector ABGs Chest x-ray
© ACS10
Adequate Oxygenation
Requires Supplemental O2 Airway Maintenance techniques
or a definitive airway Ventilation
Protect
c-spineCaution
© ACS12
Definitive Airway
Need for Airway Coma Maxillofacial injury Aspiration Airway injury
Definitive = Airway
Need For breathing Apnea Hypoxia Hypercarbia Brain Injury
Tube In trachea with cuff inflated
© ACS15
Rapid Sequence Intubation
Be prepared for surgical airway Requires skill and training
Urgency must
justify risk !
© ACS16
Surgical Airway Indications: Inability to intubate trachea
• Maxillofacial trauma
• Neck injury Methods
• Needle cricothyroidotomy with jet insufflation
• Surgical cricothyroidotomy
© ACS17
Definitive Airway
Immediate Need : Apneic Patient Suspect c-spine injury Oxygenate and ventilate Orotracheal intubation, protect c-spine If unable to intubate → Surgical airway
© ACS18
Definitive Airway
Immediate Need: Breathing Patient Suspect c-spine injury Oxygenate and ventilate as needed Oro- or nasotracheal intubation, protect
c-spine If unable to intubate → surgical airway
© ACS19
Definitive Airway
Immedieate Need : Maxillofacial Trauma Suspect c-spine injury Oxygenate and ventilate as needed If unable to intubate → surgical airway
© ACS20
Oxygenate and Ventilate
Goal: Achieve Maximal cellular O2
O2 at 10-12 liters / minute Tight-fitting oxygen reservoir mask Ventilate Avoid prolonged attempts at intubation
without oxygenation
© ACS21
Monitor Oxygenation
Pulse Oximeter Measures O2
hemoglobin sat. Utility
• Difficult
intubation • During transport
Pa O2 O2 Hgb Sat
90 mm Hg 100%
60 mm Hg 90%
30 mm Hg 60%
27 mm Hg 50%