Airway in Trauma
Orotracheal Intubation <ul><li>C-spine immobilization </li></ul><ul><ul><li>In-line stabilization </li></ul></ul><ul><ul><...
Orotracheal Intubation <ul><li>Difficult Intubation : </li></ul><ul><ul><li>Short muscular neck </li></ul></ul><ul><ul><li...
Rapid Sequence Intubation <ul><li>Prepare :   Equipment </li></ul><ul><li>Preoxygenation :  100% 3-5min </li></ul><ul><li>...
Succinylcholine <ul><li>Succinylcholine </li></ul><ul><ul><li>Dose 1.5 mg/kg </li></ul></ul><ul><ul><li>Onset 30-60 sec; d...
Sellick Maneauver <ul><li>Method : </li></ul><ul><ul><li>Cricoid pressure </li></ul></ul><ul><li>Indication : </li></ul><u...
Ketamine <ul><li>Pharmacokinetic : </li></ul><ul><ul><li>Dose 2 mg/kg; onset 60 sec; duration 15 min </li></ul></ul><ul><l...
Nasotracheal Intubation <ul><li>Contraindications : </li></ul><ul><ul><li>Apnea </li></ul></ul><ul><ul><li>Severe maxillof...
Cricothyroidotomy <ul><li>Contraindications : </li></ul><ul><ul><li>Age < 12 yr </li></ul></ul><ul><ul><ul><li>Consider ne...
Pediatric Intubation <ul><li>Sniffing position </li></ul><ul><ul><li>Without padding the occiput </li></ul></ul><ul><li>St...
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Airway In Trauma

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Airway In Trauma

  1. 1. Airway in Trauma
  2. 2. Orotracheal Intubation <ul><li>C-spine immobilization </li></ul><ul><ul><li>In-line stabilization </li></ul></ul><ul><ul><li>Do not apply traction </li></ul></ul><ul><li>Technique </li></ul><ul><ul><li>Rapid sequence intubation (RSI) </li></ul></ul><ul><ul><li>Sedation-aided intubation (SAI) </li></ul></ul>
  3. 3. Orotracheal Intubation <ul><li>Difficult Intubation : </li></ul><ul><ul><li>Short muscular neck </li></ul></ul><ul><ul><li>Mentum-hyoid distance < 3 f.b. </li></ul></ul><ul><ul><li>Open mouth < 3 cm </li></ul></ul>
  4. 4. Rapid Sequence Intubation <ul><li>Prepare : Equipment </li></ul><ul><li>Preoxygenation : 100% 3-5min </li></ul><ul><li>Premedications (3min) : </li></ul><ul><ul><li>Lidocaine 1.5 mg/kg </li></ul></ul><ul><ul><li>Pancuronium 0.01 mg/kg </li></ul></ul><ul><ul><li>Atropine 0.02 mg/kg (if < 5 yr) </li></ul></ul><ul><ul><li>Thiopental 3-5 mg/kg </li></ul></ul><ul><li>Paralysis : Succinylcholine 1.5 mg/kg </li></ul><ul><li>Pass the tube </li></ul>
  5. 5. Succinylcholine <ul><li>Succinylcholine </li></ul><ul><ul><li>Dose 1.5 mg/kg </li></ul></ul><ul><ul><li>Onset 30-60 sec; duration 4-6 min </li></ul></ul><ul><li>Contrindications </li></ul><ul><ul><li>Open globe injuries </li></ul></ul><ul><ul><li>Burns, crush injuries, or paralysis over 48 hr and under 6 wk old (cause hyperkalemia) </li></ul></ul><ul><ul><li>IICP without pretreatment (lidocaine, defasciculating agent, sedative) </li></ul></ul>
  6. 6. Sellick Maneauver <ul><li>Method : </li></ul><ul><ul><li>Cricoid pressure </li></ul></ul><ul><li>Indication : </li></ul><ul><ul><li>Prevent regurgitation and aspiration </li></ul></ul><ul><li>To apply : </li></ul><ul><ul><li>Just after the administration of succinylcholine </li></ul></ul><ul><li>To release : </li></ul><ul><ul><li>After successful intubation and ET cuff inflated </li></ul></ul>
  7. 7. Ketamine <ul><li>Pharmacokinetic : </li></ul><ul><ul><li>Dose 2 mg/kg; onset 60 sec; duration 15 min </li></ul></ul><ul><li>Advantages : </li></ul><ul><ul><li>Less respiratory depression </li></ul></ul><ul><ul><li>Intact protective airway reflexes </li></ul></ul><ul><ul><li>Does not lower BP </li></ul></ul><ul><ul><li>Bronchodilator (best choice in status asthmaticus) </li></ul></ul><ul><li>Contraindication : IICP </li></ul>
  8. 8. Nasotracheal Intubation <ul><li>Contraindications : </li></ul><ul><ul><li>Apnea </li></ul></ul><ul><ul><li>Severe maxillofacial trauma </li></ul></ul><ul><ul><li>Basilar skull fracture </li></ul></ul><ul><ul><li>Coagulopathy (coumadin, cirrhosis, hemophilia) </li></ul></ul><ul><ul><li>IICP without pretreament (lidocaine, sedative) </li></ul></ul>
  9. 9. Cricothyroidotomy <ul><li>Contraindications : </li></ul><ul><ul><li>Age < 12 yr </li></ul></ul><ul><ul><ul><li>Consider needle cricothyroidotomy + jet ventilation (30- 45min) followed by tracheostomy </li></ul></ul></ul><ul><ul><li>Laryngeal pathology (tumor, fracture, hematoma) </li></ul></ul><ul><ul><ul><li>Consider needle tracheotomy above sternal notch + jet ventilation (30- 45min) followed by tracheostomy </li></ul></ul></ul><ul><ul><li>Tracheal transection </li></ul></ul>
  10. 10. Pediatric Intubation <ul><li>Sniffing position </li></ul><ul><ul><li>Without padding the occiput </li></ul></ul><ul><li>Straight blade </li></ul><ul><ul><li>Stiffer and shorter epiglottis </li></ul></ul><ul><li>Uncuffed ET tubes </li></ul><ul><ul><li>If < 10 yr; smallest diameter at cricoid ring </li></ul></ul><ul><li>Tube size </li></ul><ul><ul><li>4 + age/4; child’s little finger </li></ul></ul>
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