Airway and Ventilation Flashcards
Frontal impact collision injuries to suspect
C spine fracture
Flail chest
Myocardial contusion
PTX
Traumatic aortic disruption
Splenic or liver laceration
Posterior hip/knee fracture/dislocation
Head injury
Facial fracture
Side impact collision injuries to suspect
Head injury
Contralateral neck sprain
C spine fracture
Flail chest
PTX
Traumatic aortic disruption
Diaphragmatic rupture
Splenic, liver or kidney laceration/fracture
Pelvic or Acetabulum fracture
Rear impact collision injuries to suspect
Head injury
C spine injury
Soft tissue injury of neck
?Chance fracture, contrecoup, diffuse axonal injury, otondoid/dens fracture of axial bone
Fall from height injuries to suspect
Head injury
Axial spine injury
Visceral abdominal injury
Pelvic and Acetabulum injury
Bilateral lower extremity fractures incl calcaneal (heel)
Thermal injury suspected injury pattern
Circumferential eschar on chest or extremities
Occult trauma - smoke inhalation, suspect in HCO >10%, often accompanied with burns >20% TBSA
Electrical burns suspected injury pattern
Cardiac arrhythmias
Myonecrosis/Compartment syndrome
Occult trauma - deeper in tissues
Thrombosis and nerve injury
Inhalation burns suspected injury pattern
CO poisoning
Upper airway swelling
Pulmonary oedema
may require increased burn resuscitation
Secondary survey examination
Head: Scalp palpation, external examination of face, eye and ear examination, visual acuity.
Minimise oedema by elevation of head revese Trendelenburg. Perform ocular before facial oedema
Maxfax: Bony crepitus, deformity, airway obstruction, cribiform plate fracture, contraindications for NGT
Neck:
Inspect, palpate and ausultate keeping in mind MOI
Review for airway obstruction, hoarseness
Review for laryngeal fracture, haematoma, bruits
Chest: IAEPR, XR
Abdo pelvis: IPPA, XR, FAST, DPL, CTAP, CTKUB, CT angio
Perineum: Contusion, haematoma, laceration, urethral blood
Rectum: Sphincter tone, pelvic fracture, rectal wall integrety, haemorrhage
Vagina: Haemorrhage, lacerations, retained products, amniochorionic fluid
MSK: Contusion, deformity, pain, perfusion, full neuro examination, reflexes. Repeat before and after splinting/cast
Back: spinal tenderness, ecchymosis, external injury sites
Neuro: GCS, Pupils, lateralising signs.
Injuries at high risk of developing compartment syndrome
Long bone fractures, Crush injuries, Circumferential thermal injuries, prolonged ischaemia, electrical burns
Signs of airway compromise
Head or neck injury, agitation, abnormal breathing pattern - accessory, rocking resp, Cheyne-Stokes
low sats
tracheal deviation
surgical emphysema
change in vioice
additional sounds
absent BS
High risk individuals for compromised ventilation
Unconscious + HI
Obtunded - intoxication, drugs
Thoracic injury
Facial burns
Inhalation injury
LEMON assessment of airway
Look externally
Evaluate 3-3-2 rule
Mallampati
Obstruction
Neck mobility
Indication for definitive airway
A - Inability to maintain airway, impending airway compromise
B - cannot maintain oxygenation w mask or apnoeic
C - Cerebral hypoperfusion resulting in obtundation or combativeness
D - GCS < 8, sustained seizure activity, head injury - obtunded
Airway adjuncts
Suction
Laryngeal manipultion - BURP
Gum elastic bougie if orotraheal intubation unsuccessful
RSI: anaesthetic, analgesia and neuromuscular blocking agent
Poor mask seal in edentulous patient - likely toofless geri
Pack gauze between cheeks and gum
Sign of accidental oesophageal intubation
Borborygmi with inspiration - bowel sounds
No CO2 detected
What are signs of adequate ventilation
ABG, end tidal CO2 4.0-5.7kPa
Indication for surgical airway
Edematous glottis
Laryngeal frature
Oropharyngeal haemorrhage obstructing airway
Inability to place ETT via vocal cord
