Airway evaluation.ppt
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This document discusses airway evaluation, management of difficult airways, and intubation. It outlines indications for intubation including resuscitation, prevention of lung soiling, positive pressure ventilation, and respiratory failure. Successful intubation requires proper positioning, equipment, and alignment of the mandible, tongue-mandible joint, and cervical spine. Tests like Mallampatti and Wilson scores can predict difficulty. Management involves securing expected difficult airways awake and having backup plans for unexpected difficulties to maintain oxygenation. Complications of intubation include inadequate ventilation, esophageal intubation, airway obstruction, and trauma.
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This document discusses airway evaluation, management of intubation, and complications. It outlines indications for intubation including resuscitation, prevention of lung soiling, and respiratory failure. Successful intubation requires a normal anatomy of the mandible, temporomandibular joint, atlanto-occipital joint, and cervical spine. Proper equipment and gadgets are also needed. Tests like the Mallampatti and Wilson scores can predict difficulty, and a history of previous issues is also informative. Securing the airway awake is recommended for expected difficult airways, and maintenance of oxygenation should be the primary aim with backup plans in place for unexpected difficulties.
Airway Evaluation and Management
This document discusses airway evaluation, management of intubation, and complications. It outlines indications for intubation including resuscitation, prevention of lung soiling, and respiratory failure. Successful intubation requires a normal mandible, throat, and cervical spine alignment. Proper equipment and gadgets are also needed. Difficult airways can be predicted by history, examination of the face, jaw, and neck, and tests like Mallampatti. Securing the airway awake is recommended for expected difficult airways. Maintaining oxygenation is the primary goal, and backup plans should be in place in case of unexpected difficult intubation.
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Trauma is a leading cause of death worldwide, especially among young adults. In India, over 84,000 people die from trauma each year, resulting in significant economic losses. There are three peaks in trauma mortality: within seconds or minutes due to airway obstruction or hemorrhage; within hours also due to hemorrhage or brain injury; and after 24 hours due to infection or multiple organ failure. Advanced Trauma Life Support (ATLS) protocols emphasize rapid assessment and stabilization of the airway, breathing, circulation, disability level, and exposure to prevent further harm. The primary survey is followed by a full secondary survey and ongoing reevaluation to identify all injuries and provide definitive care.
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1. The initial assessment of a trauma patient involves a primary, secondary, and tertiary survey to identify injuries and form a treatment plan.
2. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Establishing an airway is the top priority.
3. A secondary survey involves a full head-to-toe examination, medical history, and diagnostic tests to identify all injuries and inform management.
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2. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure. Establishing an airway is the top priority.
3. A secondary survey involves a full head-to-toe examination, medical history, and diagnostic tests to identify all injuries and inform management.
4. A tertiary survey before discharge identifies any previously missed injuries. Regional or general anesthesia may be used depending on the injuries.
Initial assessment and primary management
The document discusses management of trauma patients. It covers the key steps in the golden hour including airway management, breathing, circulation, disability assessment and exposure. It details approaches to airway control including adjuncts like oropharyngeal and nasopharyngeal airways. Signs of life-threatening thoracic injuries like tension pneumothorax are outlined. Treatment of hemorrhagic shock focuses on stopping blood loss, restoring perfusion and minimizing contamination through fluid resuscitation and hemorrhage control.
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1. The document outlines the initial assessment and management of multiply injured patients, including preparation, triage, primary survey, resuscitation, secondary survey, and definitive care.
2. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure/Environmental control to identify life-threatening conditions.
3. The secondary survey includes a full physical exam and history taking to identify additional injuries before transferring the patient to definitive care. Continuous reevaluation is important to detect any deterioration.
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This document provides an overview of airway assessment and management. It discusses assessing the airway based on history, physical exam including tests like Mallampati score, and tertiary exams. The goals of airway management are maintaining a patent airway to allow for gas exchange. Difficult airways can occur due to anatomical abnormalities. Proper preparation includes thorough assessment, having a back-up plan, and calling for help if needed. Skills like manual techniques and use of airway devices are important for supporting the airway.
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2) It describes how to evaluate and treat life-threatening injuries found during the primary survey, such as tension pneumothorax, hemothorax, flail chest, and hemorrhagic shock.
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The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
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Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
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2) Assessing the airway includes evaluating level of consciousness, ability to phonate, handle secretions, and anticipated clinical course. Ventilatory or oxygenation failure are also indications for intubation.
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1. The document outlines the initial assessment and management of multiply injured patients, including preparation, triage, primary survey, resuscitation, secondary survey, and definitive care.
2. The primary survey focuses on the ABCDEs - Airway, Breathing, Circulation, Disability, and Exposure/Environmental control to identify life-threatening conditions.
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This document provides an overview of airway assessment and management. It discusses assessing the airway based on history, physical exam including tests like Mallampati score, and tertiary exams. The goals of airway management are maintaining a patent airway to allow for gas exchange. Difficult airways can occur due to anatomical abnormalities. Proper preparation includes thorough assessment, having a back-up plan, and calling for help if needed. Skills like manual techniques and use of airway devices are important for supporting the airway.
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2) It describes how to evaluate and treat life-threatening injuries found during the primary survey, such as tension pneumothorax, hemothorax, flail chest, and hemorrhagic shock.
3) Once the primary survey is complete and life threats addressed, the secondary survey and monitoring begins along with diagnostic tests to identify and treat all injuries.
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To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
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1.Initial impression
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TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
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1) The patient, a 28-year old man involved in a motorbike accident, has an impaired airway as evidenced by snoring, rapid breathing, and low oxygen saturation.
2) The top priority is securing the patient's airway. Basic airway maneuvers and adjuncts like chin lift, jaw thrust, oropharyngeal airway are appropriate first steps given intact reflexes.
3) If the airway cannot be maintained or there is impending compromise, more invasive techniques like intubation may be needed while protecting the cervical spine. Assessing risk factors can help predict difficult airways requiring specialized equipment or procedures like surgical airway.
Prinary survey ATLS
The initial assessment of a trauma patient involves a primary survey consisting of a rapid assessment of the airway, breathing, circulation, disability, and exposure (ABCDE). For a 34-year-old male brought to the emergency room after a road traffic accident with hoarseness, low blood pressure and rapid heart rate and breathing, the primary steps would be to open and secure the airway, assess breathing for tension pneumothorax, control bleeding, check neurological status, and fully expose the patient for further examination and resuscitation efforts. A secondary survey would then obtain a full history and examine all body regions for potential injuries.
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Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort. Post-Menstrual Smell- When to Suspect Vaginitis.pptx
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Airway evaluation.ppt
- 2. Indications of intubation Resuscitation (CPR) Prevention of lung soiling Positive pressure ventilation (GA) Pulmonary toilet Patent airway (coma or near coma) Respiratory failure(CO2 retention )
- 3. Requirement of successful intbatin 1-Normal roomy mandible 2-Normal T-M, A-O , and C-spine
- 4. Requirements of successful intubation 3-Alignment of 3 axes or Assuming sniffing position -Any anomaly in these 3 joints A-O, T-M or C-spine can result In difficult intubation
- 5. Requirement of successful intubation Proper equipment -Bag and mask,oxygen source -Airways oro and nasopharyngeal -Laryngosopes different blades -ETT different sizes -suction on
- 7. Management I-History: previous history of difficulty is the best predictor Inquire about:-Nature of difficulty -No of trials -Ability to ventilate bet trials -Maneuver used -Complications II-Snoring and sleep apnea( prdictors of DMV)
- 8. Examination -Look for any obvious anomaly Morbid obesity(BMI) Skull Face Jaw Mouth,teeth Neck
- 9. Examination I-The 3 joints movements A-O joint(15-20 degrees) Presence of a gap bet the Occiput and C1 is essential The cervical spine(range>90) T.M joint:-interdental gap(3 fingers) -subluxation (1 finger)
- 10. Examination II-Measurements of the mandible -Thyro-mental distance (head extended) Normally 6.5 cm Less than 6 cm=expect difficulty
- 11. Tests to predict difficulty Mallampatti test: Based on the hypothesis That when the base of the Tongue is disproportionally Large it will overshadow the larynx
- 12. -Simple easy test,correlates with what is seen during laryngoscopy or Cormack-Lehene grades ,but 1-moderate sensitivity and specificity(12% false +ve) 2-Inter observer variation 3-Phonation increases false negative view
- 13. II-Wilson test -Consists of 5 easily assessed factors Body wight(n=0 ,>90=1,>110=2) Head and neck movement Jaw movement Receding jaw Buck teeth Each factor assigned as o ,1 ,2 max is 10
- 14. Difficult airway Expected from history,examination Secure airway while awake under LA Unexpected different options Priority for maintenance of patent airway and oxygenation
- 15. Airway gadgets
- 18. Confirm tube position Direct visualization of ETT between cords Bronchoscopy ;carina seen Continuous trace of capnography 3 point auscultation Esophageal detector device Other as bilateral chest movement,mist in the tube,CXR
- 19. Rapid sequence induction Indications Technique: -Preoxygenation -IV induction with sux -Cricoid pressure -Intubate, inflate the cuff ,confirm position -Release cricoid and fix the tube
- 20. Complications of intubation 1-Inadequate ventilation 2-Esophageal intubation 3-Airway obstruction 4-Bronchospasm 5-Aspiration 6- Trauma 7-Stress response
- 21. Recommendations Adequate airway assessment to pick up expected D.A to be secured awake Difficult intubation cart always ready Pre oxygenation as a routine Maintenance of oxygenation not the intubation should be your aim Use the technique you are familiar with Always have plan B,C,D in unexpected D.A