Advanced Trauma Life Support ATLS Student Course Manual 2018

AIRWAY MANAGEMENT 27
Asymmetry suggests splinting of the rib
cage, pneumothorax, or a flail chest. Labored
breathing may indicate an imminent threat to
the patient’s ventilation.
2. Listen for movement of air on both sides of
the chest. Decreased or absent breath sounds
over one or both hemithoraces should alert the
examiner to the presence of thoracic injury.
(See Chapter 4: Thoracic Trauma.) Beware of a
rapid respiratory rate, as tachypnea can indicate
respiratory distress.
3. Use a pulse oximeter to measure the patient’s
oxygen saturation and gauge peripheral
perfusion. Note, however, that this device
does not measure the adequacy of ventilation.
Additionally, low oxygen saturation can be an
indication of hypoperfusion or shock.
Pitfall
Failure to
recognize
inadequate
ventilation
prevention
• Monitor the patient’s respiratory
rate and work of breathing.
• Obtain arterial or venous blood
gas measurements.
• Perform continuous capnography
4. Use capnography in spontaneously breathing and
intubated patients to assess whether ventilation
is adequate. Capnography may also be used
in intubated patients to confirm the tube is
positioned within the airway.
Airway management
Clinicians must quickly and accurately assess patients’
airway patency and adequacy of ventilation. Pulse
oximetry and end-tidal CO 2
measurements are essential.
If problems are identified or suspected, take immediate
measures to improve oxygenation and reduce the risk
of further ventilatory compromise. These measures
include airway maintenance techniques, definitive
airway measures (including surgical airway), and
methods of providing supplemental ventilation.
Because all of these actions potentially require
neck motion, restriction of cervical spinal motion is
necessary in all trauma patients at risk for spinal injury
until it has been excluded by appropriate radiographic
adjuncts and clinical evaluation.
High-flow oxygen is required both before and
immediately after instituting airway management
measures. A rigid suction device is essential and should
be readily available. Patients with facial injuries can
A
B
C
D
n FIGURE 2-3 Helmet Removal. Removing a helmet properly is a two-person procedure. While one person restricts movement of the cervical
spine, (A), the second person expands the helmet laterally. The second person then removes the helmet (B), while ensuring that the helmet
clears the nose and occiput. After the helmet is removed, the first person supports the weight of the patient’s head (C). and the second
person takes over restriction of cervical spine motion (D).
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