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Airway and Ventilatory Management

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Objectives Indentify 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 technicques.

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Airway Obstruction Recognition

Listen Normal speech → No obstruction Noisy breathing → Obstruction

• Gurgle • Stridor • Hoarseness

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Airway Obstruction Coma Aspiration Maxillofacial

trauma Neck trauma

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Airway Obstruction Recognition

Look Aglitation / obtunded ↓Air movement Retraction /”rocking” respirations Deformity Airway debris

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Adequate Breathing

Provide supplemental oxygen Subtle deterioration of breathing

• Coma • Spinal cord injury • Direct chest traumaCaution

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Airway Obstruction Recognition

Feel Maxillofacial/ laryngeal crepitus Tracheal deviation Hematoma

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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

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Inadequate Breathing

Feel Subg emphysema Chest wall

crepitus / tenderness Tracheal deviation

Adjuncts Pulse oximeter CO₂ detector ABGs Chest X- Ray

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Adequate OxygenationRequires Supplemental O₂ Airway Maintenance techniques or

definitive airway Ventilation

Protect c-spineCaution

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Airway Maintenance

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Definitive AirwayNeed for Airway Coma Maxillofacial injury Aspiration Airway injury

Definitive = Airway

Need For breathing Apnea Hypoxia Hypercarbia Brain Injury

Tube In trachea with cuff inflated

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Definitive Airway

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Right Bronchial Intubation

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Rapid Sequence Intubation Be Prepared for surgical airway Requires skill and training

Urgency must justify risk !

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Surgical Airway Indications: Inability to intubate trachea • Maxilofacial Trauma • Neck injury Methods • Needle cricothyroidotomy with jet

insufflation • Surgical cricothyroidotomy

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Definitive AirwayImmediate Need : Apneic Patient Suspect c-spine injury Ogxygenate and ventilate Oroctarcheal intubation, protect c-spine If unable to intubate → Surgical airway

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Definitive AirwayImmediate 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

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Definitive AirwayImmedieate Need : Maxillofacial Trauma Suspect C-spine injury Oxygenate and ventilate as needed If unable to intubate → surgical airway

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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

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Monitor Oxygenation

Pulse Oximeter

Measures O₂ hemoglobin sat

Untility• Difficult intubation • During transport

PaO₂ O₂ Hgb Sat

90 mm Hg 100%60 mm Hg 90%30 mm Hg 60%27 mm Hg 50%

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O₂/ Hgb Dissociation Cure

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Questions

?

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Summary Suspect airway compromise Protect C- spine Open airway and ventilate If in doubt → Definitive airway

• Urgency of need • Clinical judgment and skill

Adequate O₂ delivery