Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 2 n Airway and Ventilatory Management
algorithm applies only to patients who are in acute
respiratory distress or have apnea, are in need of an
immediate airway, and potentially have a c-spine
injury based on the mechanism of injury or physical
examination findings. (Also see functional Airway
Decision Scheme on MyATLS mobile app.)
The first priority of airway management is to ensure
continued oxygenation while restricting cervical spinal
motion. Clinicians accomplish this task initially by
positioning (i.e., chin-lift or jaw-thrust maneuver)
and by using preliminary airway techniques (i.e.,
nasopharyngeal airway). A team member then passes
an endotracheal tube while a second person manually
restricts cervical spinal motion. If an endotracheal tube
cannot be inserted and the patient’s respiratory status
is in jeopardy, clinicians may attempt ventilation via
a laryngeal mask airway or other extraglottic airway
device as a bridge to a definitive airway. If this measure
fails, they should perform a cricothyroidotomy. These
methods are described in detail in the following sections.
(Also see Airway Management Tips video on MyATLS
mobile app.)
Airway Maintenance Techniques
In patients who have a decreased level of consciousness,
the tongue can fall backward and obstruct the
hypopharynx. To readily correct this form of obstruction,
healthcare providers use the chin-lift
or jaw-thrust maneuvers. The airway can then be
maintained with a nasopharyngeal or oropharyngeal
airway. Maneuvers used to establish an airway can
produce or aggravate c-spine injury, so restriction
of cervical spinal motion is mandatory during
these procedures.
n FIGURE 2-5 The Chin-Lift Maneuver to Establish an Airway. Providers
should avoid hyperextending the neck when using this maneuver.
displace the mandible forward (n FIGURE 2-6). When used
with the facemask of a bag-mask device, this maneuver
can result in a good seal and adequate ventilation. As
in the chin-lift maneuver, be careful not to extend the
patient’s neck.
Nasopharyngeal Airway
Nasopharyngeal airways are inserted in one nostril
and passed gently into the posterior oropharynx.
They should be well lubricated and inserted into the
nostril that appears to be unobstructed. If obstruction
is encountered during introduction of the airway, stop
and try the other nostril. Do not attempt this procedure
in patients with suspected or potential cribriform
plate fracture. (See Appendix G: Airway Skills and
Nasopharyngeal Airway Insertion video on MyATLS
mobile app.)
Chin-Lift Maneuver
The chin-lift maneuver is performed by placing the
fingers of one hand under the mandible and then
gently lifting it upward to bring the chin anterior.
With the thumb of the same hand, lightly depress
the lower lip to open the mouth (n FIGURE 2-5). The
thumb also may be placed behind the lower incisors
while simultaneously lifting the chin gently. Do
not hyperextend the neck while employing the
chin-lift maneuver.
Jaw-Thrust Maneuver
To perform a jaw thrust maneuver, grasp the angles
of the mandibles with a hand on each side and then
n BACK TO TABLE OF CONTENTS
n FIGURE 2-6 The Jaw-Thrust Maneuver to Establish an Airway.
Advanced Trauma Life Support for Doctors
Avoid extending the patient’s neck.
Student Course Manual, 9e
American College of Surgeons
Figure# 02.05
Dragonfly Media Group
09/19/2011
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WC
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