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Mnemonic- VISA A (Step by step

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1. Ventilatory support
a. Respiratory arrest
b. Respiratory failure
i. Hypoventilation/Hypercarbia
1. paCO2 >55 mmHg
ii. Arterial Hypoxemia refractory to oxygen
1. paO2 <55 RA, <70 on 100% face mask
iii. Respiratory Acidosis
c. Need for prolonged Ventilatory support
2. Ill patient
a. Severe chest injury (e.g. Flail Chest or Pulmonary Contusion)
b. Severe Closed Head Injury (GCS<8)
3. Shock: Class III or IV Hemorrhage with poor perfusion
4. Airway protection
a. Unconscious patient (Glasgow Coma Scale <=8)
b. Severe maxillofacial trauma
c. Aspiration risk
i. Bleeding into upper airway
ii. Vomiting
iii. Unable to speak or swallow
d. Airway obstruction risk
i. Neck hematoma
ii. Tracheal injury
iii. Stridor
iv. Inhalation burn or other Inhalation Injury (with cord edema)
v. Prolonged Seizure
e. Multiple trauma, Head Injury and abnormal mental status
5. Anticipated Transfer of critically ill patient

Inhalation burn or other Inhalation Injury (with cord edema) e. Hypoventilation/Hypercarbia i. Ventilation and Oxygenation 1. Stridor d. Vomiting c. Multiple trauma. Prolonged Seizure 5. Airway obstruction risk a. paCO2 >55 mmHg b. Unconscious patient (Glasgow Coma Scale <=8) 2. Bleeding into upper airway b. Airway Protection 1.Indications (Details) A. Tracheal injury c. Respiratory arrest 2. Head Injury and abnormal mental status B. Neck hematoma b. Aspiration risk a. <70 on 100% face mask . Unable to speak or swallow 4. Respiratory failure a. Severe maxillofacial trauma 3. paO2 <55 RA. Arterial Hypoxemia refractory to oxygen i.

fpnotebook. Severe Closed Head Injury (GCS<8) (Source: Family Practice Notebookhttp://www. Flail Chest or Pulmonary Contusion) 6.com/lung/procedure/AdvncdArwy. Severe chest injury (e.g.c. Respiratory Acidosis 3. Class III or IV Hemorrhage with poor perfusion 5.htm) . Need for prolonged Ventilatory support 4.