ACS

1
Airway and Ventilatory
Management
ACS
2
Objectives

Identify 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 techniques
ACS
3
Airway Obstruction


Coma
Aspiration
Maxillofacial
trauma
Neck trauma


ACS
4
Airway Obstruction Recognition
Look
Agitation / obtunded
Air movement
Retraction /rocking respirations
Deformity
Airway debris
ACS
5
Airway Obstruction Recognition
Listen
Normal speech No obstruction
Noisy breathing Obstruction
Gurgle
Stridor
Hoarseness
ACS
6
Airway Obstruction Recognition
Feel
Maxillofacial / laryngeal crepitus
fractures
Tracheal deviation
Hematoma
ACS
7
Adequate Breathing
Provide supplemental oxygen
Subtle deterioration of breathing

Coma
Spinal cord injury
Direct chest trauma
Caution
ACS
8
Inadequate Breathing

Look
Cyanosis
in mental status
Chest asymmetry
Tachypnea
Neck vein
distention
Paralysis

Listen
I cant breathe !
Stridor, wheezes
or absent breath
sounds
ACS
9
Inadequate Breathing
Feel
Subq. emphysema
Chest wall
crepitus / tenderness
Tracheal deviation
Adjuncts
Pulse oximeter
CO
2
detector
ABGs
Chest x-ray


ACS
10
Adequate Oxygenation
Requires
Supplemental O
2

Airway Maintenance techniques
or a definitive airway
Ventilation
Protect
c-spine

Caution
ACS
11
Airway Maintenance


ACS
12
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

ACS
13
Definitive Airway

ACS
14
Right Bronchial Intubation


ACS
15
Rapid Sequence Intubation
Be prepared for surgical airway
Requires skill and training


Urgency must
justify risk !
ACS
16
Surgical Airway
Indications: Inability to intubate trachea
Maxillofacial trauma
Neck injury
Methods
Needle cricothyroidotomy with jet
insufflation
Surgical cricothyroidotomy
ACS
17
Definitive Airway
Immediate Need : Apneic Patient
Suspect c-spine injury
Oxygenate and ventilate
Orotracheal intubation, protect c-spine
If unable to intubate Surgical airway
ACS
18
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
19
Definitive Airway
Immedieate Need : Maxillofacial Trauma
Suspect c-spine injury
Oxygenate and ventilate as needed
If unable to intubate surgical airway
ACS
20
Oxygenate and Ventilate
Goal: Achieve Maximal cellular O
2

O
2
at 10-12 liters / minute
Tight-fitting oxygen reservoir mask
Ventilate
Avoid prolonged attempts at intubation
without oxygenation
ACS
21
Monitor Oxygenation
Pulse Oximeter
Measures O
2

hemoglobin sat.
Utility
Difficult
intubation
During transport
Pa O
2
O
2
Hgb Sat

90 mm Hg 100%
60 mm Hg 90%
30 mm Hg 60%
27 mm Hg 50%

ACS
22
O
2
/ Hgb Dissociation Cure
ACS
23
Questions
ACS
24
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
2
delivery