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ACS

Airway and Ventilatory

Management

Objectives

ACS

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

Airway Obstruction

Coma
Aspiration
Maxillofacial
trauma
Neck trauma

ACS

Airway Obstruction Recognition

Look

Agitation / obtunded

Air movement
Retraction /rocking respirations
Deformity
Airway debris

ACS

Airway Obstruction Recognition

Listen

Normal speech No obstruction

Noisy breathing Obstruction

Gurgle
Stridor
Hoarseness

ACS

Airway Obstruction Recognition

Feel

Maxillofacial / laryngeal crepitus

fractures

Tracheal deviation

Hematoma

ACS

Adequate Breathing

Provide supplemental oxygen

Subtle deterioration of breathing

Caution

Coma
Spinal cord injury
Direct chest trauma

ACS

Inadequate Breathing
Listen
Look

Cyanosis
I cant breathe !

in mental status Stridor, wheezes

Chest asymmetry

or absent breath

Tachypnea
sounds
Neck vein distention
Paralysis

ACS

Inadequate Breathing
Feel

Subq. emphysema

Chest wall
crepitus / tenderness

Tracheal deviation

Adjuncts

Pulse oximeter
CO detector
2

ABGs
Chest x-ray

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ACS

Adequate Oxygenation
Requires
Supplemental O
2

Airway Maintenance techniques

or a definitive airway
Ventilation
Caution

Protect
c-spine

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Airway Maintenance

ACS

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ACS

Definitive Airway
Need for Airway

Need For breathing

Coma
Maxillofacial injury
Aspiration
Airway injury
Definitive
Airway

Apnea
Hypoxia
Hypercarbia
Brain Injury

Tube In trachea
with cuff inflated

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Definitive Airway

ACS

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Right Bronchial Intubation

ACS

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ACS

Rapid Sequence Intubation

Be prepared for surgical airway

Requires skill and training

Urgency must
justify risk !

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ACS

Surgical Airway

Indications: Inability to intubate trachea

Maxillofacial trauma
Neck injury
Methods
Needle cricothyroidotomy with jet
insufflation
Surgical cricothyroidotomy

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ACS

Definitive Airway
Immediate Need : Apneic Patient

Suspect c-spine injury

Oxygenate and ventilate

Orotracheal intubation, protect c-spine

If unable to intubate Surgical airway

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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

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ACS

Definitive Airway
Immedieate Need : Maxillofacial Trauma

Suspect c-spine injury

Oxygenate and ventilate as needed

If unable to intubate surgical airway

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ACS

Oxygenate and Ventilate

Goal: Achieve Maximal cellular O2

O2 at 10-12 liters / minute

Tight-fitting oxygen reservoir mask

Ventilate
Avoid prolonged attempts at intubation
without oxygenation

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ACS

Monitor Oxygenation
Pulse Oximeter

Measures O2
hemoglobin sat.
Utility
Difficult

intubation
During transport

Pa O2

O2 Hgb Sat

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

100%
90%
60%
50%

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ACS

O / Hgb Dissociation Cure

2

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ACS

Questions

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Summary

Suspect airway compromise

Protect c-spine
Open airway and ventilate
If in doubt Definitive airway
Urgency of need
Clinical judgment and skill
Adequate O2 delivery

ACS