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    MARIA PALOMA MARTINEZ SENDRA
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    airway ATLS 10 edition

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    airway ATLS 10 edition

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    29 views14 pages

    ATLS Airway

    Uploaded by

    MARIA PALOMA MARTINEZ SENDRA
    airway ATLS 10 edition

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 14
    PART I: Basic and Advanced Airway Management Detailed Guidelines Timeline: 60 minutes SKILLS INCLUDED IN THIS SKILL STATION BASIC AIRWAY SKILLS + Jaw-thrust maneuver + Insertion of nasopharyngeal airway + Safe use of suction LEARNING OBJECTIVES By the end ofthis sll station, you will beable to safely and effectvely |. Assess alrway patency ina simulated trauma patient scenario. 2. Apply a non-rebreathing mask to maximize ‘oxygenation, 3. Apply a pulse oximeter. 4, Perform a jaw thrust on a manikin to provide an adequate airway. ADVANCED AIRWAY MANAGEMENT 6. Insert 2 nasopharyngeal airway and oropharyngeal 7. Perform one-person end two-person bag-mask 8. Insert a supraglottic or extraglottie device on 2 9, State the indications for a definitive airway. + Insertion of oropharyngeal airway + One-person bag-mask ventilation, + Two-person bag-mask ventilation, + Insertion of laryngeal mask airway + Insertion of laryngeal tube airway + Oral endotracheal intubation Demonstrate airway suctioning on a manikin, sleway on a manikin, ventilation on a manikin manikin 10, Attempt oral endotracheal intubation on a manikin. 53 54 SECTION2» CHAPTER | m Skill Station Guidelines ENVIRONMENT, EQUIPMENT REQUIRED Prellavian he stselOlis aon ESE Na ae Fics NI Na MANAGEMENT EQUIPMENT NUMBER Ade tbat main i | EOUPHENT nuraen | ‘Adu arway mask: seas 2 sees teach Adult intubation manikin 1 Bogrmask device tadute Bagmesk device ' Cereal eater 1 Adu airway mash, 2nes ach nygen mask and tubing \ ‘Oxygen mask and ebing 1 Tongue blades 2 (OPA various snes teach ‘Oropharyngeal always: various sites teach NAc varous sas Nese Nesopharyngest ainwaye various sizes each Suction rigid 1 Suction: sof rigid teen Lanygoseope handle and blade, curved cach ad sealant Extra bulbs for laryngoscope ECG pads 3 {xtra batteries for arngoscope Blood pressure (87) cut ' Cenvelcll ' stethoscope 1 Edotrachel tube snes 6,7,8 lof each ye protacton, masks glove, ae foupie 1 and gowns (to reinforce universal ceases Endotracheal tube (ETT) stylet 1 Video and Radiograph Resources: + Video : Insertion of NazopharyngealAlrway ‘Adutearyngeal mask airway (LMA)or | | + Video? Insertion of Oropharyngeal Away Laryngeal tube sirway (LTA) vatious sizes + Video 3 Bagtask Vertiation \o-mL syrings ' Tepe, tIneh Halt Lubricant C0, end-tidal colorimetric 1 conmiavod EQUIPMENT REQUIRED |) ADVANCED AIRWAY |) MANAGEMENT (continueo) [ EQUIPMENT Pulse oximeter probe ' ‘Seethorcope ‘ Disposable gloves, mash ye protection and owns (to reinforce universal precsutions) Video and Radiograph Resources: + Video 4: Insertion of Lanyngesl Mask Away + Video S: Acute Oral Endotrachea Intubation + Vidoo 6 Gum Elastic Bougie 0 CONTENT INTRODUCTION This skill station focuses on the A for “airway” in the ATLS ABCDE algorithm. ‘Aim: To provide the students with an opportunity to apply the knowledge they have gained on airway evaluation and management from both the ATLS Manual and the interactive discussions/mATLS and to facilitate the acquisition of specific airway skills. ‘The airway skills have been divided into sections to facilitate teaching of skills and to more easi time. Remember, assessment and intervention must begin with basic skills and then progress to more advanced maneuvers. ‘This skill station focuses on the basic and advanced airway assessmentand management skills hatareused during the primary survey. RELEVANCE OF CONTENT Anobstructed airway is invariably fatal ifnot corrected, The goal of airway managementisto open the airway to allow for gas exchange. In the vast majority of trauma Patients, basicalrway maneuvers, plus or minus simple adjuncts, are sufficient to meet this goal and form SKILL STATIONA m Airway 55 the focus ofthis skill station. When these efforts fal, advanced airway skills may be required to ensure the trauma patient receives adequate oxygenation and. ventilation. Students are unlikely to become competent inendotracheal intubation during this brief skill station, but it is considered an essential skill and as such should be taught using the ATLS model for teaching a psychomotor skill. The knowledge component has been explained in the textbook and addressed in the interactive discussion; this skill station is a chance for students to apply the knowledge in a practical setting, so they can useiit on a patient, worn, Aes As the instructor, you will be providing the students. witha scenario to contextualize their practice Encourage the students to: + Answer the stimulus questions. + Practice their skills and apply their knowledge (this isnot a mini-leeture|. + Actively participate and practice skills so they ‘canbe assessed. 56 Eireann tcl ha ah Before commencing the skills teaching, the instructor should: + Review the cognitive components of when the skills are indicated /contraindicated and discuss any special considerations (e.g., NPA is indicated. when the patient would gag on an OPA), + Establish each student's prior experience with the skills so that the instructor can determine in which order students will undertake the skill and be able to use the experience of the group. SECTION 2» CHAPTER | m Skill Station Guidelines ‘When teaching theskill, utilize the S-step ATLS model of skill acquisition 1. Instructor undertakes a real-time run-through ofthe skill without explanation for the students, demonstrating the steps. 2, Instructor talks through the skill for the students, demonstrating the steps while explaining them. 3, Student talks instructor through procedure while the instructor performs the procedure. 4, Student demonstrates procedure (while next student talks through the procedure). 5. Instructor provides first student with feedback on performance, ‘Thecyclecontinuesunilallstudentshavetalkedthrough the till, demonstrated the skll,and received feedback. DIALOGUE CASE SCENARIO Mz A 22-year-old man was riding a bicycle down ahill,lost control while braking, and fell off. He was not wearing a helmet. He was able to talk at the scene and his friends have brought him to the hospital His friends tell you he vomited several times during the journey to the hospital | STIMULUs QUESTION azzezzment? and had to be assisted out of the car onarrival. S: Vital signs: HR 88/min; BP 124/65; SAO, 96% on roomair; RR16 /min T: No prehospital treatment On initial airway assessment, the patient was able to speak and was not breathless. KEY DISCUSSION POINTS (IF NOT RAISED BY THE STUDENTS) Speak tothe patient and ask him his name and what eccurred Ihe is able to speak, his arway snot Likely to be obstructed. fhe is not breathless when he speaks, hs breathing kely adequate preliminary «Further asesement can proceed with esse thanif he was unable to speak or was estas * Assosement should begin with ooking 3 the patient to a8 whether there Is evidence of facil trauma or burns + The mouth shouldbe Inepected for evidence of bleeding vomitus, or broken or toore teeth + Usten for noay airway sounds, STIMULUS QUESTION. ‘what management 7 Intervention would you Perform atthe ime? : KEY DISCUSSION POINTS (IF NOT RAISED BY THE STUDENTS) Supplemental oxygen should be provided tothe patient This is ueully with »wgh-fing ‘oxygen mask, Once the mask is applied fogzing ofthe mask shouldbe seen ‘A pulee oximeter should be applied to the finger ang the oxygen saturation should be noted + ECG leads should be applied to allow continuous monitoring of heart rate and assessment ofthe patients rhythm, + Amanual or automsted blood pressure cu can be placed to measure blood pressure, with Incerval repeat, SKILL STATIONA m Airway 57 Seay oman JAW=THRUST, MANEUVER + The patient does not appear to be distressed. His eyes are closed, he is not responding to speech, and there is no obvious facial injury. + There are no added airway sounds and fogging visible on an oxygen mask. «+ The patient starts snoring, KEY DISCUSSION POINTS (F NOT RAISED THE STUDENTS) STIMULUS QUESTION What does enoring + Snoring indestes part Indiate and what are airway obstruction, your options? ‘mort tkely apposition of the tongue with the pesterior pharyngeal wal, Reassss the airway with + Simple away maneuvers ‘should be implemented twopen the airway + Jaw thrust preferable ‘over chin if. as theres loss chance of nad vortently moving the cervical spe Instructor Note: You may choose to combine jaw thrust, suction, and insertion of nasal and oral airways as {single skill o save time. You may choose to show the video in lieu of a silent run-through for any of the skills, Prmiey Cone Le SL REN When teaching the sil utlie the S:step ATLS model of shi acquisition: 1 Instructor undertakes a real-time run-through ofthe al without explanation forthe students demonstrating the steps. 2. Instructor talks trough the ski forthe students, demonstrating the steps while explaining them. 5 Student talks instructor through procedure while the Instructor performs the procedure 4, Student demonstrates procedure (while next student talks through the procedure) 5. Instructor provges frst student with Feedback on performance ‘The cycle continues until all students have talked through ‘the skill, demonstrated the sl, and reeoived Feedback. SKILL STEPS, STEP. Stand atthe head ofthe patient, Leaking down schim STEP2. Place the midatetinger ofyourrghthand atthe angle ofthe patient’ jaw on the right STEP3, Placethe mile inger of your left hand at the sngle ofthe patient’ jaw on the Loft STEP 4 Apply upward pressure to elevate the man- ible, which wil Ue posterior pharynx. the tongue from the 58 SECTION 2» CHAPTER | m Skill Station Guidelines CASE SCENARIO PROGRESSION USE OF SAFE SUCTION Application of the jaw thrust relieves the sn on release the snoring recurs. Instructor Note: Use the following resources: g, but. Pee Ul eet aaa Pirro «+ Video 1: Insertion of Nasopharyngeal Airway When teaching the ski utile the S-step ATLS model of skill acquisition: + Video 2: Insertion of Oropharyngeal Airway woes + Video 3: Bag-Mask Ventilation | Instructor undertakes 2 real-time run-through , ofthe sill without explanation for the students, KEY DISCUSSION demonstrating the steps STIMULUS QUESTION POINTS (IF NOTRAISED 2. Instructor talks through the sil for the students, BY THE STUDENTS) demonstrating the steps white expaining ther. 4 Student talks Instructor through procedure white the What does this ingieate + This ndlcates the arway Instructor performs the procedure about the sioway, \spartally obstructed, 4. Student demonstrates procedure while next student cand what are your and thie needs to be talks through the procedure) management options? addressed immediately 5. Instructor provides fist student with feedback on ‘An NPA may rliove this performance. + InsereNPA before ‘The cycle continues until all students have talked through attempting OPA,asthere eel, demonstrated the sll and received feedback isa possibilty of an ‘tact gag reftex. SKILL STEPS Suetion should only be ‘sed gurgling ic heard lor there eval gud STEP. Turn on the vacuum, aelacting 4 midpoint (50 ‘mim Ha) rather tran ful vacuum (300 mm Ha In te aeway STEP2. Gently open the mouth nspecuing or bleeding. + Thereieno indication for lacerations oF broten teeth. Look for the supported venation presence of vile uid, blood. or debris. ith bagemas at this STEPS. _Gentiy place the suction catheter In the: Petre ‘repharynx ang nasopharynx, Keeping the suction device (Yankauer] upin view ata umes INSERTION OF NASOPHARYNGEAL AIRWAY Pree US Eo eT CCC ULL SKILL STATIONA m Airway 59 INSERTION. OF [oI l NTN ame OM eee Corea ata ‘When teaching the sil, uslize the S.step ATLS model of ski acquisition: | Ingtructor undertakes 2 rel-time run-through ofthe ski without explanation Fer the students, demonstrating the steps 2. Instructor talks through the skill for the students, demonstrating the steps white explaining them, {3 Student talks instructor through procedure while the Instructor performs the procedure 4. Student demonstrates procedure (while next student talks through the procedure) 5 Instructor provides frst student with feedback on performance, The cycle continues until al students have talked through ‘the sh, demonstrated the sil. and received feedback SKILL STEPS Note: Do not use a nasopharyngeal airway in patient with mldface fractures or suspected bsllar skull fracture STEPL Assess the nasal passages for any apparent cbszucton eg, peyps racures,orhematrhage) STEP2. Select the proper sizeof airway Look at the nostril dameter to determine the greatest size that will pass easly through the nostri. STEP. Lubricate the nasopharyngeal airway with a water-soluble bricant or fap water STEP 4 wth the paser’s head in neural postion, stan te the side of the patent Holding the NPA Uke 3 penal, gently inser the op ofthe arway into the nosviland.irect posteriorly andtoward theca. STEPS. Gentlyinsersthe nasopharyngeal airway through the nostril into the hypopharyne witha slight rotating mation, until the flange rests against thenostil If duringirsertontheNPA meets any resistance, remove the NPAandartemptinserion ‘on the other nde Ifthe NPA causes the patent ‘> cough or gue. slighty withdraw the NPA to relieve the cough or gagand then proceed. STEP 6, Reassess the patient to ensure thatthe away Isnow patent ‘When teaching the all, ute the S-stop ATLS model of ‘hil acquistin: |. Instructor undertake a real-time run-throueh ‘ofthe sil without explanation for the students demonstrating the steps. 2 Instructor talks through the skill forthe students,

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