airway dr. Tom ATLS

Ensure adequacy of the airway
Confirm adequacy of ventilation
Define “definitive airway”
Maintain adequate oxygenation in all
phases of airway management
How do I know the airway is adequate?
How do I know ventilation is adequate?
How do I know oxygenation is adequate?
What are the pitfalls?
…talks clearly?
…is hoarse?
…cannot respond?
…is intubated?
Airway is adequate
Management: Observation and selective
intubation
High index of concern with
• Maxillofacial injury
• Soft-tissue injury of neck
• Facial or neck burns
Laryngeal injury
Laryngeal / tracheal burn
Management: Evaluate and perform
• Careful endoscopic exam
• Careful and gentle intubation, or
• Surgical airway?
GCS Score<9
Obstruction due to
• Tongue
• Aspiration
• Foreign body
• Maxillofacial injury
• Neck injury
Cyanosis
Rocking respirations
Decreased or no air exchange
Face or neck crepitus
Neck hematoma or swelling
Simple management maneuvers
• Suction
• Chin lift
• Jaw thrust
“Definitive airway:” Cuffed tube in
trachea
Assess for sign of obstruction
Confirm correct ET tube position
Auscultate in medial axillae
Assess oxygenation (pulse oximeter)
Assess ventilation (CO2 detector)
Obtain chest x-ray
Protect the
cervical spine
during airway
management !
What do I see?
What do I feel?
What do I hear?
What do I measure?
What might I find?
How do I manage the patient?
Respiratory rate and effort
Respiratory distress / labored
Cyanosis
Restlessness / anxiety
Chest asymmetry / paradoxical
breathing
Crepitance
Local tenderness
Asymmetric
respiratory
excursion
Noisy breathing
Asymmetric breath sounds
Absent breath sounds
Mental status
Vital signs
Pulse oximetry
End-tidal CO2
ABGs
Tension pneumothorax
Pneumothorax
Hemopneumothorax
Malpositioned ET tube
Neurologic deficit
Direct neck /chest injury
Establish an appropriate airway
Administer supplemental oxygen
Decompress the chest
Reposition the ET tube
Provide mechanical ventilation
Perform a surgical airway
Mental status evaluation
Vital signs
Pulse oximetry
ABGs
Airway versus ventilation
RSI— Inability to intubate
Dislodged / malpositioned ET tube
Aspiration
Equipment failure
How do I know the airway is adequate?
How do I know ventilation is adequate?
How do I know oxygenation is adequate?
What are the pitfalls?