The document outlines the essential learning objectives for airway and ventilatory management, including recognizing airway compromise and establishing a patent airway. It emphasizes the importance of early intervention and monitoring for signs of airway obstruction and inadequate ventilation. Additionally, it discusses techniques for airway maintenance and the necessity of definitive airway management in certain clinical scenarios.

1. Airway &
Ventilatory Management

2. Learning Objectives
 Identify the clinical settings in which airway
compromise is likely to occur
 Recognize the signs and symptoms of acute
airway obstruction.
 Describe the techniques to establish and
maintain a patent airway and confirm the
adequacy of ventilation and oxygenation,
including pulse oximetry monitoring (and CO2
colorimetric monitoring)
 Define “definitive airway” and outline the
steps needed to maintain oxygenation
before, during, and after establishing a
definitive airway.

3. Airway Problems are a common
cause of Preventable Deaths
 Failure to recognize airway need
 Technical difficulties
 Inability to establish airway
 Failure to correct an incorrectly placed airway
 Dislodgement of a correctly placed airway
 Delay in establishing adequate
ventilation
 Aspiration of Gastric Contents

4. Clinical Scenarios increasing risk
 Head Injury (decreased
consciousness)
 Facial Fractures
 Direct Airway Injury
 Hoarseness, s/c
emphysema & palpable #
 Thoracic Injury

5. Objective Signs of Airway Obstruction
 Look if agitated / obtunded
Agitation  hypoxia,
Obtunded  Hypercarbia
Using accessory muscles?
 Listen for abnormal sounds
Noisy breathing is obstructed breathing
 Feel the trachea

6. Problem recognition
 Assuring an adequate airway is only the
first step
 The patient need to be ventilating
adequately
 Ventilatory compromise
 Airway obstruction
 Altered ventilatory mechanics
 CNS depression

7. Is my patient breathing enough ?

8. Objective Signs of Inadequate Ventilation
 Look for chest wall
movement
 Listen for movement of
air in both lungs
Tachypnea may mean
air hunger
 Use a pulse oximeter
 Oxygen saturation
 Peripheral perfusion

9. Management
 A rigid suction device is essential, all
trauma victims need supplemental O2
 Airway maintenance
 Chin lift
 Jaw thrust
 Oropharyngeal airway
 Nasopharyngeal airway

10. Position for unconscious
patient

11. A definitive airway requires a
tube present in trachea with
cuff inflated, connected to
some form of oxygen enriched
assisted ventilation and
secured in place with tape

12. When do we need a definitive
airway?
 Need for airway protection
 Unconscious
 Severe maxillofacial trauma
 Risk of aspiration (bleeding, vomiting)
 Risk of obstruction (neck hematoma,
laryngeal & tracheal injury, stridor)

13. When do we need a definitive
airway?
 Need for ventilation
 Apnea
 Neuromuscular paralysis
 Unconscious
 Inadequate effort
 Tachypnea, cyanosis
 Hypoxia
 Hypercarbia
 Severe head injury (for hyperventilation)

14. Definitive Airway –
Endotracheal intubation

15. In line cervical stabilization

16. Cricoid pressure to prevent aspiration

17. Facio-maxillary trauma

18. Mid Face # causing airway compromise

19. Definitive Airway  Surgical
Cricothryroidotomy

20. Cricothyroidotomy

21. Site & Incision

22. Tube insertion

23. Tracheostomy for facio-maxillary tauma

24. Head & Neck Burns
Premptive tracheostomy

25. Oxygenation
 A measured saturation of 95 % or
greater by pulse oximetry is a strong
corroborative evidence of adequate
peripheral arterial oxygenation
 Pitfalls
 Profound anemia
 hypothermia

26. Ventilation
 Bag valve – mask
technique
 Ventilators
 Beware of problems
of positive pressure
ventilation like
conversion of simple
to tension
pneumothorax, or
creation of
pneumothorax
Barotrauma from ventilator

27. Pitfalls
 Inability to intubate
 Inability to provide surgical airway
 Trauma patient may vomit & aspirate (suction
available)
 Gastric distension from ventilation with mask
 aspiration & hypotension from IVC
pressure
 Equipment may fail (laryngoscope bulb,
batteries, cuff rupture, oximeter probe)

28. ?

29. Summary
 Actual or impending airway obstruction
should be suspected in all injured patients.
 With all airway maneuvers, the cervical
spine must be protected by in-line
immobilization.
 Clinical signs suggesting airway
compromise should be managed by
securing a patent airway and providing
adequate oxygen-enriched ventilation.
 A definitive airway should be inserted if there
is any doubt on the part of the doctor as to
the patient’s airway.

30. Summary - 2
 A definitive airway should be placed early after
the patient has been ventilated with oxygen-
enriched air, and prolonged periods of apnea
must be avoided.
 Airway management requires assessment and
reassessment of airway patency, tube
position, and ventilatory effectiveness.
 The selection of orotracheal or nasotracheal
routes for intubation is based on experience
and skill level of the doctor.
 Surgical airway is indicated whenever an
airway is needed and intubation is
unsuccessful.