Editing Trauma - airway/breathing (section)

== AIRWAY MANAGEMENT ==

* Ensure continued oxygenation while restricting spinal movement
* Manoeuvres
** Chin-lift
** Jaw-thrust
** Be careful not to extend neck
** NPA
*** Beware patients with suspected midface fracture
** OPA
*** If patient tolerates this, they are highly likely to require intubation
** If intubation fails or is unlikely to succeed, try LMA
*
* GCS of 8 or less requires prompt intubation

Intubation

* Drugs
** Indicated for patients that need airway control, but have intact gag reflexes
** Complication occurs if you can't then establish an airway - need to bag-valve mask until paralysis wears off
** Induction agent
*** ATLS recommends etomidate 0.3mg/kg
** Muscle relaxant
*** Succinylcholine 1-2mg/kg (often 100mg)
* Insert laryngoscope
* Pass bougie blindly beyond oesophagus, with angled tip positioned anteriorly
* Confirm tracheal position by feeling clicks as distal tip rubs along cartilaginous ribs of trachea
* Pass endotracheal tube over bougie
** If held up at arytenoids or aryepiglottic folds, withdraw slightly and turn counter-clockwise 90 degrees
* Remove bougie and confirm tube position with auscultation of breath sounds and capnography
* Inflate cuff and institute assisted ventilation

Surgical airway

* Cricothyroidotomy or tracheostomy
** Cricothyroidotomy is preferable in emergency
* Indications
** Oedema of glottis
** Fracture of larynx
** Severe oropharyngeal haemorrhage
** Inability to intubate vocal cords
* Needle cricothyroidotomy
** 12-14 gauge canula through cricothyroid membrane
** Can then be connected to oxygen with a Y-connector
** Can be adequately oxygenated for 30-45 mins, but CO2 slowly builds up
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[[Category:Trauma]]