Airway and Ventilatory management Flashcards
Which patients should receive supplemental Oxygen?
All trauma patients
What can a combative / agitated patient be a sign of
Altered mental state secondary to:
- HI
- Intoxication
- Hypoxia
- Hypercapnia
Definitive airway definition
Tube inserted into trachea with cuff inflated below level on vocal cords, and connected to oxygen enriched assisted ventilation
Signs of airway compromise include
Head / neck injury
Tachypnoea
Agitation
Low SpO2
Stridor / snoring
Absent breath sounds in fields
Subcutaneous emphysema at head, neck or chest
Deviated trachea
Patients at risk of compromised ventilation
Unconscious with HI
Obtunded pt (intoxication or hypercapnia)
Thoracic injuries
Facial burns
Inhalation injuries
Purpose of a definitive airway in patients at risk of compromised ventilation
Provide an airway
Deliver supplemental O2
Support ventilation
Prevent aspiration
Signs of potential airway obstruction in maxillofacial trauma
Fractures of Nasopharynx / Oropharynx
Oropharyngeal haemorrhage
Dislodged teeth
Triad of laryngeal fracture signs
Hoarse voice
Subcutaneous emphysema
Palpable fracture
Sign of ventilation problems caused by C spine injury
Diaphragmatic breathing
Compromised ability to meet rising oxygen demands
Sign of ventilation problem caused by complete cervical cord transection
Abnormal breathing
Paralysis of intercostal muscles
Causes of asymmetrical chest wall movements
Splinting rib cage
Pneumothorax
Flail chest
Causes of reduced breath sounds to hemithorax
Thoracic injury - haemo / pneumothorax
Indications of definitive airway placement
A - impending or potential airway compromise
B - apnoea or inability to maintain adequate oxygenation by facemask
C - agitation due to cerebral hypoperfusion
D - GCS 8 or lower, sustained seizure activity, protect against aspiration
Helmet removal process
2 people
Person 1 provides manual inline motion restriction from below
Person 2 expands the sides of helmet and removes from above
Re-establish inline restiction from above and secure the head and nec during airway management
Factors indicating difficult airway
Obese
Beard
Elderly / Paediatric
Spinal trauma / arthritis / immobilisation
Edentate
Maxillofacial / mandibular trauma
Mnemonic for assessing an airway
LEMON
Look externally
Evaluate 3-3-2 rule
Mallampati
Obstruction / Obesity
Neck mobility
3-3-2 rule for airway assessment
Mouth opening distance between incisors 3 fingers
Mandible to hyoid distance 3 fingers
Floor of mouth (?or hyoid bone) to thyroid cartilage distance 2 fingers
Mallampati class 1
Soft palate
Uvula
Fauces
Pillars
Mallampati 2
Soft palate
Uvula
Fauces
Mallampati 3
Soft palate
Base of uvula
Mallampati 4
Hard palate only visible
Contraindications to nasopharyngeal or oropharyngeal airways
Basal skull fracture
Midface fractures
Methods of intibation
Orotracheal intubation
Nasotracheal intubation
Technique preferred for intubation of trauma patient
3 person technique:
Person 1 inserts tube (always test inflation of cuff)
Person 2 provides adjuncts (eg. suction, bougie, cricoid pressure) and connects tube to ventilator support
Person 3 provides C spine stabilisation
Options when unable to intubate
Use recue airway devices
Needle cricothyroidotomy followed by surgical airway
Establish surgical airway
Rapid sequence induction indications
Pt needs intubation but intact gag reflexes
Pt sustained head injury
RSI drug options
Ketamine / Thiopentone / Propofol
Suxamethonium / Rocuronium
Fentanyl / Opioid
Benefit of using Ketamine in RSI
Raises BP rather than causing hypotension which most other agents do
Needle cricothyroidotomy
Provides oxygen until definitive airway can be placed
Preferred for children < 12 yrs of age
Percutaneous transtracheal oxygenation technique (PTO)
Surgical cricothyroidotomy
Usually preferable to emergency tracheostomy
Not recommended for children < 12 yrs of age
Cricoid pressure technique
BURP
Backwards, Upwards and Rightward pressure
Complications of positive pressure ventilation following intubation
Converting simple pneumothorax to tension pneumothorax
Causing pneumothorax secondary to barotrauma
Method to improve mask seal in edentate patients
Pack space between cheeks and gum with gauze
Methods to assess sufficient ventilation
ABG
Continual end tidal carbon dioxide analysis
Indications for a surgical airway (cricothyroidotomy or tracheostomy)
Oedema of the glottis
Larynx fracture
Severe oropharyngeal haemorrhage that obstructs airway
Inability to place endotracheal tube through vocal cords
