The document discusses various techniques for securing a patient's airway during trauma care including orotracheal intubation, rapid sequence intubation, and cricothyroidotomy. It provides details on indications, contraindications, and proper techniques for different airway management procedures depending on a patient's age, injuries, and other factors. Guidelines are given for assessing difficult airway features, appropriate medications and dosages, and special considerations for pediatric patients.

1. Airway in Trauma

2. Orotracheal Intubation C-spine immobilization In-line stabilization Do not apply traction Technique Rapid sequence intubation (RSI) Sedation-aided intubation (SAI)

3. Orotracheal Intubation Difficult Intubation : Short muscular neck Mentum-hyoid distance < 3 f.b. Open mouth < 3 cm

4. 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

5. 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)

6. 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

7. 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

8. Nasotracheal Intubation Contraindications : Apnea Severe maxillofacial trauma Basilar skull fracture Coagulopathy (coumadin, cirrhosis, hemophilia) IICP without pretreament (lidocaine, sedative)

9. 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

10. 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