Advanced Trauma Life Support ATLS Student Course Manual 2018
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Advanced Trauma Life Support ATLS Student Course Manual 2018

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04.12.2017 Views

CHAPTER 2 Outline Objectives iNtroduction Airway • Problem Recognition • Objective Signs of Airway Obstruction Ventilation • Problem Recognition • Objective Signs of Inadequate Ventilation Management of OxygeNAtion mANAgement of Ventilation Teamwork Chapter Summary BibliogRAphy Airway Management • Predicting Difficult Airway Management • Airway Decision Scheme • Airway Maintenance Techniques • Definitive Airways OBJECTIVES After reading this chapter and comprehending the knowledge components of the ATLS provider course, you will be able to: 1. Identify the clinical situations in which airway compromise are likely to occur. 2. Recognize the signs and symptoms of acute airway obstruction. 3. Recognize ventilatory compromise and signs of inadequate ventilation. 5. Describe the techniques for confirming the adequacy of ventilation and oxygenation, including pulse oximetry and end-tidal CO 2 monitoring. 6. Define the term “definitive airway.” 7. List the indications for drug-assisted intubation. 8. Outline the steps necessary for maintaining oxygenation before, during, and after establishing a definitive airway. 4. Describe the techniques for maintaining and establishing a patent airway. n BACK TO TABLE OF CONTENTS 23

24 CHAPTER 2 n Airway and Ventilatory Management The inadequate delivery of oxygenated blood to the brain and other vital structures is the quickest killer of injured patients. A protected, unobstructed airway and adequate ventilation are critical to prevent hypoxemia. In fact, securing a compromised airway, delivering oxygen, and supporting ventilation take priority over management of all other conditions. Supplemental oxygen must be administered to all severely injured trauma patients. Early preventable deaths from airway problems after trauma often result from: •• Failure to adequately assess the airway •• Failure to recognize the need for an airway intervention •• Inability to establish an airway •• Inability to recognize the need for an alternative airway plan in the setting of repeated failed intubation attempts •• Failure to recognize an incorrectly placed airway or to use appropriate techniques to ensure correct tube placement •• Displacement of a previously established airway •• Failure to recognize the need for ventilation There are many strategies and equipment choices for managing the airway in trauma patients. It is of fundamental importance to take into account the setting in which management of the patient is taking place. The equipment and strategies that have been associated with the highest rate of success are those that are well known and regularly used in the specific setting. Recently developed airway equipment may perform poorly in untrained hands. airway and/or ventilatory compromise. Therefore, initial assessment and frequent reassessment of airway patency and adequacy of ventilation are critical. During initial airway assessment, a “talking patient” provides momentary reassurance that the airway is patent and not compromised. Therefore, the most important early assessment measure is to talk to the patient and stimulate a verbal response. A positive, appropriate verbal response with a clear voice indicates that the patient’s airway is patent, ventilation is intact, and brain perfusion is sufficient. Failure to respond or an inappropriate response suggests an altered level of consciousness that may be a result of airway or ventilatory compromise, or both. Patients with an altered level of consciousness are at particular risk for airway compromise and often require a definitive airway. A definitive airway is defined as a tube placed in the trachea with the cuff inflated below the vocal cords, the tube connected to a form of oxygen-enriched assisted ventilation, and the airway secured in place with an appropriate stabilizing method. Unconscious patients with head injuries, patients who are less responsive due to the use of alcohol and/or other drugs, and patients with thoracic injuries can have compromised ventilatory effort. In these patients, endotracheal intubation serves to provide an airway, deliver supplemental oxygen, support ventilation, and prevent aspiration. Maintaining oxygenation and preventing hypercarbia are critical in managing trauma patients, especially those who have sustained head injuries. In addition, patients with facial burns and those with potential inhalation injury are at risk for insidious respiratory compromise (n FIGURE 2-1). For this reason, consider preemptive intubation in burn patients. Airway The first steps toward identifying and managing potentially life-threatening airway compromise are to recognize objective signs of airway obstruction and identify any trauma or burn involving the face, neck, and larynx. Problem Recognition Airway compromise can be sudden and complete, insidious and partial, and/or progressive and recurrent. Although it is often related to pain or anxiety, or both, tachypnea can be a subtle but early sign of n FIGURE 2-1 Patients with facial burns and/or potential inhalation injuries are at risk for insidious respiratory compromise, so consider preemptive intubation. n BACK TO TABLE OF CONTENTS

CHAPTER 2 Outline<br />

Objectives<br />

iNtroduction<br />

Airway<br />

• Problem Recognition<br />

• Objective Signs of Airway Obstruction<br />

Ventilation<br />

• Problem Recognition<br />

• Objective Signs of Inadequate Ventilation<br />

Management of OxygeNAtion<br />

mANAgement of Ventilation<br />

Teamwork<br />

Chapter Summary<br />

BibliogRAphy<br />

Airway Management<br />

• Predicting Difficult Airway Management<br />

• Airway Decision Scheme<br />

• Airway Maintenance Techniques<br />

• Definitive Airways<br />

OBJECTIVES<br />

After reading this chapter and comprehending the knowledge<br />

components of the <strong>ATLS</strong> provider course, you will be able to:<br />

1. Identify the clinical situations in which airway<br />

compromise are likely to occur.<br />

2. Recognize the signs and symptoms of acute<br />

airway obstruction.<br />

3. Recognize ventilatory compromise and signs of<br />

inadequate ventilation.<br />

5. Describe the techniques for confirming the<br />

adequacy of ventilation and oxygenation, including<br />

pulse oximetry and end-tidal CO 2<br />

monitoring.<br />

6. Define the term “definitive airway.”<br />

7. List the indications for drug-assisted intubation.<br />

8. Outline the steps necessary for maintaining<br />

oxygenation before, during, and after establishing a<br />

definitive airway.<br />

4. Describe the techniques for maintaining and<br />

establishing a patent airway.<br />

n BACK TO TABLE OF CONTENTS<br />

23

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