Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 2 n Airway and Ventilatory Management
n FIGURE 2-9 The i-gel® supraglottic airway. The tip of the airway
should be located into the upper esophageal opening. The cuff
should be located against the laryngeal framework, and the incisors
should be resting on the integral bite-block.
n FIGURE 2-11 Example of a multilumen esophageal airway.
balloon, and the other port is ventilated. Using a CO 2
detector provides evidence of airway ventilation.
The multilumen esophageal airway device must be
removed and/or a definitive airway provided after
appropriate assessment. End tidal CO 2
should be
monitored, as it provides useful information regarding
ventilation and perfusion.
DEFINITIVE AIRWAYS
n FIGURE 2-10 Example of a laryngeal tube airway.
that allows intubation through the LTA. The LTA is
not a definitive airway device, so plans to provide a
definitive airway are necessary. As with the LMA, the
LTA is placed without direct visualization of the glottis
and does not require significant manipulation of the
head and neck for placement.
Multilumen Esophageal Airway
Some prehospital personnel use multilumen esophageal
airway devices to provide oxygenation and
ventilation when a definitive airway is not feasible.
(n FIGURE 2-11). One of the ports communicates with the
esophagus and the other with the airway. Personnel
using this device are trained to observe which port
occludes the esophagus and which provides air to the
trachea. The esophageal port is then occluded with a
Recall that a definitive airway requires a tube placed
in the trachea with the cuff inflated below the vocal
cords, the tube connected to oxygen-enriched assisted
ventilation, and the airway secured in place with an
appropriate stabilizing method. There are three types
of definitive airways: orotracheal tube, nasotracheal
tube, and surgical airway (cricothyroidotomy and
tracheostomy). The criteria for establishing a definitive
airway are based on clinical findings and include:
••
A —Inability to maintain a patent airway by
other means, with impending or potential airway
compromise (e.g., following inhalation injury,
facial fractures, or retropharyngeal hematoma)
••
B —Inability to maintain adequate oxygenation
by facemask oxygen supplementation, or the
presence of apnea
••
C —Obtundation or combativeness resulting
from cerebral hypoperfusion
••
D —Obtundation indicating the presence of a
head injury and requiring assisted ventilation
(Glasgow Coma Scale [GCS] score of 8 or less),
sustained seizure activity, and the need to
protect the lower airway from aspiration of
blood or vomitus
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