2. Airway & Ventilatory Management Flashcards
Triad of clinical signs of laryngeal fracture:
Hoarseness
Subcutaneous emphysema
Palpable fracture
What airway/ventilatory issue would lead to agitation?
Hypoxia
What airway/ventilator issue would lead to drowsiness?
Hypercarbia
What does cyanosis indicate?
Late sign of hypoxaemia
What does abdominal / diaphragmatic breathing indicate?
Diaphragm is working, but intercostal and abdominal muscle contributions are gone. Typically due to spinal injuries below C3.
Define a definitive airway
- Tube in the trachea
- Cuff inflated below vocal cords
- Tube connected to O2 enriched assisted ventilation
- Airway secured in place
What are the three types of definitive airway?
- Orotracheal tube
- Nasotracheal tube
- Surgical airway (cricothyroidotomy, tracheostomy)
What are the indications for a definitive airway?
- Need for airway protection
- Maxfax fractures (blood aspiration risk)
- Neck injuries (neck haematoma, neck burns, tracheal injury etc)
- Head injury (unconsciousness) - Need for ventilation or oxygenation
- Inadequate respiratory effort
- Progressive change
- Accessory muscle use
- Respiratory muscle paralysis
- Neurological deterioration
What are contraindications to nasotracheal intubation
Facial, frontal sinus, basilar skull and cribriform plate fractures are relative contraindications.
(raccoon eyes, Battle’s sign, CSF leaks).
What laryngeal manipulation is helpful in visualising the vocal cords when intubating?
BURP:
- Backwards, upwards, rightwards pressure
What is the advantage of cricoid pressure|?
Stops aspiration.
But can limit view of vocal cords.
What is an eschmann tracheal tube introducer (ETTI)
A boujie
Give an example of an induction cocktail for intubation, including doses
0.3mg/kg etomidate
100mg succinylcholine
Indications for surgical airway
Oedema of glottis
Fracture of larynx
Severe oropharyngeal haemorrhage obstructing airway
Inability to place ETT
