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Chapter 4 Initial Airway Management

Chapter 4 Initial Airway Management. Initial Airway Management. Overview. Respiratory anatomy and physiology Importance of observation Supplemental oxygen, various airway adjuncts Indications, contraindications, advantages, disadvantages Predictors of difficulty

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Chapter 4 Initial Airway Management

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  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 Airway -

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

  5. Anatomy and Physiology Airway -

  6. Anatomy and Physiology Nasopharynx • Delicate • Turbinates Oropharynx • Hyoid bone Hypopharynx • Epiglottis Airway -

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

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

  9. Average Adult Distances can vary by several cm. 2–2.5 cm movement in flexion/extension Airway -

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

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

  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 Airway -

  13. MMAP: Mallampati Score Airway -

  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 Airway -

  15. Patent Airway Noisy breathing is obstructed breathing. Airway -

  16. Normal Perfusion Normal oxygenation • PaO2: 100 mmHg Pulse oximetry • Goal: maintain SpO2 >95% • Monitor SpO2 with all trauma patients • Monitor SpO2 with any respiratory compromise Airway -

  17. Supplemental Oxygen Airway -

  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 Airway -

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

  20. When in doubt, give oxygen! Airway -

  21. Positive Pressure Ventilation rate • 10–12 per minute Non-intubated patient • 8–10 per minute Intubated patient Supplemental oxygen essential Suction must be immediately available • Avoid gastric distention Monitor lung compliance Airway -

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

  23. Difficult BVM Ventilation B Beards O Obesity O Older patients TToothlessness S Snores or stridor Airway -

  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 Airway -

  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 doubt—give oxygen! Airway -

  26. Discussion Airway -

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