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ACS

Airway and Ventilatory

Management
Focused Discussion

ACS

Objectives

Identify when airway compromise will occur.

Recognize acute airway obstruction.
Describe techniques to establish and maintain
patent airway.
Define definitive airway.
Demonstrate definitive airway with c-spine
protection.
Demonstrate ventilatory techniques.

ACS

Key Questions

Is the airway adequate?

Is there adequate ventilation?
How do you monitor gas exchange?
What are the pitfalls?

ACS

Key Question

Is the airway adequate?

When does airway compromise occur?

How do you determine it?
What can you do about it?
How do you confirm proper tube
placement?

ACS

When does airway compromise occur?

Coma
Aspiration
Maxillofacial
trauma
Neck trauma

ACS

How do you determine it?

Look
Look for cyanosis
Air movement
Retraction/rockingrespirations
Deformity
Airway debris

ACS

How do you determine it?

Listen

Normal speech
No obstruction
Noisy breathing
Obstruction

Feel

Maxillofacial /
laryngeal creptius
Tracheal deviation
Hematoma

ACS

What can you do about it?

Simple Maneuvers
Suction
Chin lift
Jaw thrust
Definitive Airway: Cuffed tube in
airway via mouth, nose, neck

ACS

How to confirm tube placement?

Look
Listen
Pulse Oximetry
Chest X-ray
COdetector

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ACS

Caution!
Protect the cervical
spine during
airway management!

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ACS

Key Questions

Is the airway adequate?

Is there adequate ventilation?
How do you determine it?
What is the cause?
What can you do about it?

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ACS

How do you determine it?

Cyanosis?
, absent, or noisy breath sounds
in mental status
Chest asymmetry
ABGS

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ACS

What is the cause?

Pneumothorax
Hemopneumothorax
Tension pneumothorax
Malpositioned endotracheal tube
Neurologic
Direct neck / chest injury

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ACS

What can you do about it?

Reposition endotracheal tube

Decompress the chest
Administer supplemental O
Provide mechanical ventilation
Nedle cricothyroidotomy / jet
insufflation

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ACS

Key Questions

Is the airway obstructed?

Is there adequate ventilation?
How do you monitor gas exchange?

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ACS

How do you monitor gas exchange?

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ACS

Key Questions

Is the airway adequate?

Is there adequate ventilation?
How do you monitor gas exchange?
What are the pitfalls?

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ACS

What are the pitfalls?

Airway versus ventilation

RSI inability to intubate
Dislodged / malpositioned endotracheal
tube
Aspiration
Equipment failure

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ACS

Questions

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ACS

Summary

Is the airway adequate?

Is there adequate ventilation?
How do you monitor gas exchange?
What are the pitfalls?