Airway In Trauma
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Airway In Trauma

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Airway In Trauma Airway In Trauma Presentation Transcript

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