Via aerea

1. Airway Management

2. Airway Care
• Begins before touching the patient
– MOI will determine the need for spinal
immobilization
– Talking to your patient may provide clues
• Airway care is a continuum
– Simple to advanced airways
• May change at any time
– Reassessment is key

3. Airway Control During Primary
Assessment
• Hands on
– Trauma jaw thrust
– Trauma chin lift
– Head tilt–chin lift if
required
• Positioning
– Supine/neutral
– Log roll to clear airway

4. Airway Adjuncts
• Basic
– Oral, nasal, suctioning
• Intermediate
– Dual lumen, supraglottic
airway devices, laryngeal
tube airways
• Advanced
– Tracheal intubation
– Surgical airway

5. Pharmacology for
Airway Control
• Premedication agents
– L: Lidocaine
– O: Opiates
– A: Atropine
– D: Defasciculating dose
• Induction agents
– Rapid loss of consciousness
• Neuromuscular blocking agents
– Paralyzation

6. Ventilation
• Below 10 or above 29 require care
– High-flow oxygen is first step
– Assist ventilations if they remain too
high or too low
• Assisted ventilations
– 10 to12 breaths per minute
– Deep enough to fill chest

7. Monitoring
• Oxygenation
– Pulse oximetry
• CO oximetry
• End-tidal CO2
– Capnometry
• Normal is 30 to 40 mm Hg
– Capnography
• Waveforms may help
diagnose problems

8. Difficult Airways
• Can the patient ventilate on his or her own?
– SpO2 > 92% on high-flow oxygen
• Beyond the scope of practice of team on
scene?
– Where is next level?
• Evaluate ability to use bag-mask device
• Have a backup means to maintain airway

9. Head Injury
• Prevention of secondary injury
– Hypoxia
– Hypotension
– Minimize increased ICP
• Prolonged attempts at intubation increase
hypoxia
• Reduce risk of increasing ICP with airway
– Gag reflex increases ICP
– Pharmacologic agents may decrease reflex

10. Cervical Spine Trauma
• Begins with assessing MOI
• Trauma jaw thrust, trauma chin
lift
• Intubation with in-line stabilization
• If the patient is awake but
requires ventilation, intubate in an
awake state
• If the patient is uncooperative,
consider sedation and paralytics

11. Severe Maxillary Facial Trauma
• Clear the airway
– Suction, bleeding control, positioning
• Endotracheal intubation may still be placed if
available
• Surgical airway is often needed
• Transport with the least invasive airway that
permits oxygenation

12. Injury to the
Larynx or Trachea
• Internal and external trauma
• Recognize early
– Swelling, stridor, external wounds, free air
• Treatment is based on status of the airway
• Intubation
– May require smaller ETT
– If resistance is met, abort attempt
• May require surgical airway

13. Airway Disruption
• Most are penetrating trauma
• Positive-pressure ventilation
may worsen condition
– Negative pressure caused by
patient’s own inhalation may cause
less injury
• High-flow oxygen
– Allow patient to assume a position
of comfort if allowable

14. Summary
• Airway care starts with the basics
• There are many options for airway care
• Ventilation may be needed with or without
airway adjuncts
• All airway care requires continuous monitoring
• Think ahead and have a backup plan