AIRWAY MANAGEMENT on trauma head and thorax case.pptx

Ctgvc

1. ADVANCED TRAUMA LIFE SUPPORT dr. M Yusuf, Sp.B , Subsp.BD(K)

2. ADVANCE TRAUMA LIFE SUPPORT Simultaneous diagnostic and therapeutic activities intended to identify and treat life and limb-threatening injuries, beginning with the most immediate. The “ Golden Hour” , the first hour after traumatic injury, when emergency treatment is most likely to be successful

3. BASIC OF TRAUMA ASSESMENT

4. TRIAGE The process of categorizing victims or mass casualties based on their need for treatment and the resources available GOALS: Prevent avoidable deaths Ensure proper initial treatment within a minimal time frame Avoid misusing assets on hopeless cases

5. PRIMARY SURVEY The primary survey encompasses the ABCDEs of trauma care and identifies life-threatening conditions by adhering to this sequence: • A irway maintenance with restriction of cervical spine motion • B reathing and ventilation • C irculation with hemorrhage control • D isability(assessment of neurologic status) • E xposure/Environmental control

6. PREDICTING DIFFICULT AIRWAY MANAGEMENT Before attempting intubation , assess a patient’s airway to predict the difficulty of the maneuver . Factors that indicate potential difficulties with airway maneuvers include : C- spine injury • Severe arthritis of the c- spine Significant maxillofacial or mandibular trauma Limited mouth opening Obesity Anatomical variations (e.g., receding chin , overbite , and a short , muscular neck ) Pediatric patients

7. SIGN OF INADEQUATE VENTILATION The following steps can assist clinicians in identifying objective signs of inadequate ventilation: Look for symmetrical rise and fall of the chest and adequate chest wall excursion. Listen for movement of air on both sides of the chest . Decreased or absent breath sounds over one or both hemithoraces should alert the examiner to the presence of thoracic injury Use a pulse oximeter to measure the patient’s oxygen saturation and gauge peripheral perfusion.

8. AIRWAY AND VENTILATORY MANAGEMENT Maintenance of Airway Patency: Suction of Secretions Chin Lift/Jaw Thrust Nasopharyngeal Airway/Oropharyngeal Airway Airway Support Oxygen NRBM (100%) Bag Valve Mask Definitive Airway: Endotracheal Intubation Surgical Crichothyroidotomy Tracheostomy

9. AIRWAY MANAGEMENT (HELMET REMOVAL) While one person restricts movement of the cervical spine (A) The second person expands the helmet laterally. The second person then removes the helmet (B) While ensuring that the helmet clears the nose and occiput. After the helmet is removed, the first person supports the weight of the patient’s head (C) And the second person takes over restriction of cervical spine motion (D)

10. AIRWAY AND VENTILATORY MANAGEMENT The chin-lift maneuver is performed by placing the fingers of one hand under the mandible and then gently lifting it upward to bring the chin anterior. To perform a jaw thrust maneuver, grasp the angles of the mandibles with a hand on each side and then displace the mandible forward

11. AIRWAY AND VENTILATORY MANAGEMENT The preferred technique is to insert the oral airway upside down, with its curved part directed upward, until it touches the soft palate The laryngeal mask airway (LMA) and intubating laryngeal mask airway (ILMA) have been shown to be effective in the treatment of patients with difficult airways

12. AIRWAY DECISION SCHEME

13. DEFINITIVE AIRWAYS There are three types of definitive airways : orotracheal tube, nasotracheal tube, and surgical airway (cricothyroidotomy and tracheostomy). The criteria for establishing a definitive airway are based on clinical findings and include: A —Inability to maintain a patent airway by other means, with impending or potential airway compromise (e.g., following inhalation injury, facial fractures, or retropharyngeal hematoma) B —Inability to maintain adequate oxygenation by facemask oxygen supplementation, or the presence of apnea C —Obtundation or combativeness resulting from cerebral hypoperfusion D —Obtundation indicating the presence of a head injury and requiring assisted ventilation (Glasgow Coma Scale [GCS] score of 8 or less),

14. DEFINITIVE AIRWAY

15. AIRWAY MANAGEMENT Surgical cricothyroidotomy  is performed by making a skin incision that extends through the cricothyroid membrane Tracheostomy  is an operative procedure that creats a surgical airway in the cervical traceha

16. THANKYOU dr. M Yusuf, Sp.B , Subsp.BD(K)