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Airway in Trauma

Airway in Trauma. Indications. Control IICP PaCO2 : 25-30 mmHg Respiratory failure CPR, flail chest, severe shock Obtain airway Potential of airway compromise (e.g. gunshot) Protect airway Aspiration risk, thermal / caustic airway burn. Orotracheal Intubation. C-spine immobilization

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Airway in Trauma

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  1. Airway in Trauma

  2. Indications • Control IICP • PaCO2 : 25-30 mmHg • Respiratory failure • CPR, flail chest, severe shock • Obtain airway • Potential of airway compromise (e.g. gunshot) • Protect airway • Aspiration risk, thermal / caustic airway burn

  3. Orotracheal Intubation • C-spine immobilization • In-line stabilization • Do not apply traction • Technique • Rapid sequence intubation (RSI) • Sedation-aided intubation (SAI)

  4. Orotracheal Intubation Difficult Intubation : • Short muscular neck • Mentum-hyoid distance < 3 f.b. • Open mouth < 3 cm

  5. Rapid Sequence Intubation • Prepare :Equipment • Preoxygenation : 100% 3-5min • Premedications (3min) : • Lidocaine 1.5 mg/kg • Pancuronium 0.01 mg/kg • Atropine 0.02 mg/kg (if < 5 yr) • Thiopental 3-5 mg/kg • Paralysis : Succinylcholine 1.5 mg/kg • Pass the tube

  6. Succinylcholine • Succinylcholine • Dose 1.5 mg/kg • Onset 30-60 sec; duration 4-6 min • Contrindications • Open globe injuries • Burns, crush injuries, or paralysis over 48 hr and under 6 wk old (cause hyperkalemia) • IICP without pretreatment (lidocaine, defasciculating agent, sedative)

  7. Sellick Maneauver • Method : • Cricoid pressure • Indication : • Prevent regurgitation and aspiration • To apply : • Just after the administration of succinylcholine • To release : • After successful intubation and ET cuff inflated

  8. Ketamine • Pharmacokinetic : • Dose 2 mg/kg; onset 60 sec; duration 15 min • Advantages : • Less respiratory depression • Intact protective airway reflexes • Does not lower BP • Bronchodilator (best choice in status asthmaticus) • Contraindication : IICP

  9. Nasotracheal Intubation • Contraindications : • Apnea • Severe maxillofacial trauma • Basilar skull fracture • Coagulopathy (coumadin, cirrhosis, hemophilia) • IICP without pretreament (lidocaine, sedative)

  10. Cricothyroidotomy • Contraindications : • Age < 12 yr • Consider needle cricothyroidotomy + jet ventilation (30- 45min) followed by tracheostomy • Laryngeal pathology (tumor, fracture, hematoma) • Consider needle tracheotomy above sternal notch + jet ventilation (30- 45min) followed by tracheostomy • Tracheal transection

  11. Pediatric Intubation • Sniffing position • Without padding the occiput • Straight blade • Stiffer and shorter epiglottis • Uncuffed ET tubes • If < 10 yr; smallest diameter at cricoid ring • Tube size • 4 + age/4; child’s little finger

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