ACS

Airway and Ventilatory

Management

Objectives

ACS

Indentify when airway compromise will occur.

Recognize acute airway obstruction
Describe techniques to establish and maintain
Patent airway
Define definitive airway with c-spine
Protection
Demonstrate ventilatory technicques.

 ACS

Airway Obstruction Recognition

Listen

Normal speech No obstruction

Noisy breathing Obstruction

Gurgle
Stridor
Hoarseness

 ACS

Airway Obstruction

Coma
Aspiration
Maxillofacial
trauma
Neck trauma

 ACS

Airway Obstruction Recognition

Look

Aglitation / obtunded

Air movement

Retraction /rocking respirations

Deformity

Airway debris

 ACS

Adequate Breathing

Provide supplemental oxygen

Subtle deterioration of breathing

Caution

Coma
Spinal cord injury
Direct chest trauma

 ACS

Airway Obstruction Recognition

Feel

Maxillofacial/ laryngeal crepitus

Tracheal deviation

Hematoma

 ACS

Inadequate Breathing
Look

Cyanosis

in mental status

Chest asymmetry

Tachypnea

Neck vein distention

Paralysis

Listen

I can t breathe !

Stridor , wheezes

Or Absent breath
sounds

 ACS

Inadequate Breathing
Feel

Subg emphysema

Chest wall
crepitus / tenderness
Tracheal deviation

Adjuncts

Pulse oximeter

CO detector

ABGs

Chest X- Ray

 ACS

Adequate Oxygenation
Requires
Supplemental O
Airway Maintenance techniques or
definitive airway
Ventilation
Caution

Protect
c-spine

Airway Maintenance

ACS

 ACS

Definitive Airway
Need for Airway

Coma

Maxillofacial injury

Aspiration

Airway injury
Definitive
Airway

Need For breathing

Apnea

Hypoxia

Hypercarbia

Brain Injury
Tube In trachea
with cuff inflated

Definitive Airway

ACS

Right Bronchial Intubation

ACS

 ACS

Rapid Sequence Intubation

Be Prepared for surgical airway

Requires skill and training

Urgency must
justify risk !

 ACS

Surgical Airway

Indications: Inability to intubate trachea

Maxilofacial Trauma
Neck injury
Methods
Needle cricothyroidotomy with jet
insufflation
Surgical cricothyroidotomy

 ACS

Definitive Airway
Immediate Need : Apneic Patient

Suspect c-spine injury

Ogxygenate and ventilate

Oroctarcheal intubation, protect c-spine

If unable to intubate Surgical airway

 ACS

Definitive Airway
Immediate Need: Breathing Patient

Suspect c-spine injury

Oxygenate and ventilate as needed

Oro- or nasotracheal intubation protect

c-spine

If unable to intubate surgical airway

 ACS

Definitive Airway
Immedieate Need : Maxillofacial Trauma

Suspect C-spine injury

Oxygenate and ventilate as needed

If unable to intubate surgical airway

 ACS

Oxygenate and Ventilate

Goal: Achieve Maximal cellular O

O at 10-12 liters / minute
Tight-fitting oxygen reservoir mask
Ventilate
Avoid prolonged attempts at intubation
without oxygenation

 ACS

Monitor Oxygenation
Pulse Oximeter

PaO

Measures O
hemoglobin sat

Untility
Difficult
intubation
During transport

90 mm Hg
60 mm Hg
30 mm Hg
27 mm Hg

O Hgb Sat
100%
90%
60%
50%

 ACS

O/ Hgb Dissociation Cure

 ACS

Questions

Summary

Suspect airway compromise

Protect C- spine
Open airway and ventilate
If in doubt Definitive airway
Urgency of need
Clinical judgment and skill
Adequate O delivery

ACS