Ensure adequacy of the airway

Confirm adequacy of ventilation

Define definitive airway
Maintain adequate oxygenation in all
phases of airway management

 How do I know the airway is adequate?

How do I know ventilation is adequate?
How do I know oxygenation is adequate?
What are the pitfalls?

 talks clearly?
is hoarse?
cannot respond?
is intubated?

 Airway is adequate
Management: Observation and selective
intubation
High index of concern with
Maxillofacial injury
Soft-tissue injury of neck
Facial or neck burns

 Laryngeal injury
Laryngeal / tracheal burn
Management: Evaluate and perform
Careful endoscopic exam
Careful and gentle intubation, or
Surgical airway?

 GCS Score<9
Obstruction due to
Tongue
Aspiration
Foreign body
Maxillofacial injury
Neck injury

 Cyanosis
Rocking respirations
Decreased or no air exchange
Face or neck crepitus
Neck hematoma or swelling

 Simple management maneuvers

Suction
Chin lift
Jaw thrust
Definitive airway: Cuffed tube in
trachea

 Assess for sign of obstruction

Confirm correct ET tube position
Auscultate in medial axillae
Assess oxygenation (pulse oximeter)
Assess ventilation (CO2 detector)
Obtain chest x-ray

Protect the
cervical spine
during airway
management !

 What do I see?
What do I feel?
What do I hear?
What do I measure?
What might I find?
How do I manage the patient?

 Respiratory rate and effort

Respiratory distress / labored
Cyanosis
Restlessness / anxiety
Chest asymmetry / paradoxical
breathing

 Crepitance
Local tenderness
Asymmetric
respiratory
excursion

 Noisy breathing
Asymmetric breath sounds
Absent breath sounds

 Mental status
Vital signs
Pulse oximetry
End-tidal CO2
ABGs

 Tension pneumothorax
Pneumothorax
Hemopneumothorax
Malpositioned ET tube
Neurologic deficit
Direct neck /chest injury

 Establish an appropriate airway

Administer supplemental oxygen
Decompress the chest
Reposition the ET tube
Provide mechanical ventilation
Perform a surgical airway

 Mental status evaluation

Vital signs
Pulse oximetry
ABGs

 Airway versus ventilation

RSI Inability to intubate
Dislodged / malpositioned ET tube
Aspiration
Equipment failure

 How do I know the airway is adequate?

How do I know ventilation is adequate?
How do I know oxygenation is adequate?
What are the pitfalls?