Airway management in acute trauma setting emcon14 upload version
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This document discusses airway management challenges in trauma patients and strategies to address them. It notes that prevention of hypoxemia through a protected airway is the top priority in trauma. Managing the airway of trauma patients requires considering cervical spine protection, use of supplemental oxygen, basic airway techniques, potential need for a definitive tracheal tube, and challenges like injuries, patient positioning, and deciding on assisted vs. unassisted intubation. Solutions discussed include video laryngoscopy, drug-assisted intubation using ketamine or rocuronium with reversal agents, regional airway blocks, and ensuring providers have adequate training to handle difficult airways.
![Airway Management in Acute
Trauma Setting
Dr.Venugopalan .P.P
DA,DNB,MNAMS,MEM [GWU]
Director, Emergency Medicine ,Aster-DM Healthcare Ltd
Deputy Director ,Academy
Founder and Executive Director – ANGELS[Active Network Group of Life Savers ]
PG Teacher Emergency Medicine , National board of Examination
Faculty –ATLS [American College of Surgeons ]
EMCON 2014 Mumbai](https://image.slidesharecdn.com/airwaymanagementinacutetraumasettingemcon14-uploadversion-141109100030-conversion-gate02/85/Airway-management-in-acute-trauma-setting-emcon14-upload-version-1-320.jpg)
![Chapter Statement
ATLS [ACS]
Prevention of
hypoxemia
requires a
protected,
unobstructed
airway and
adequate
ventilation, which
take priority over
management of all
other conditions.
EMCON 2014 Mumbai](https://image.slidesharecdn.com/airwaymanagementinacutetraumasettingemcon14-uploadversion-141109100030-conversion-gate02/85/Airway-management-in-acute-trauma-setting-emcon14-upload-version-3-320.jpg)
Airway management in acute trauma setting emcon14 upload version
- 1. Airway Management in Acute Trauma Setting Dr.Venugopalan .P.P DA,DNB,MNAMS,MEM [GWU] Director, Emergency Medicine ,Aster-DM Healthcare Ltd Deputy Director ,Academy Founder and Executive Director – ANGELS[Active Network Group of Life Savers ] PG Teacher Emergency Medicine , National board of Examination Faculty –ATLS [American College of Surgeons ] EMCON 2014 Mumbai
- 2. Lecture focus • Why airway management in Trauma ? • How it is different ? • What are the challenges? • How to solve it? EMCON 2014 Mumbai
- 3. Chapter Statement ATLS [ACS] Prevention of hypoxemia requires a protected, unobstructed airway and adequate ventilation, which take priority over management of all other conditions. EMCON 2014 Mumbai
- 4. Airway in Trauma Priority -1 C-Spine protection EMCON 2014 Mumbai
- 6. Definitive airway Tube placed in the trachea with the cuff inflated below the vocal cords, Connected to some form of oxygen-enriched assisted ventilation, Airway secured in place EMCON 2014 Mumbai
- 7. Airway Management How do I manage the airway of a trauma patient? ● Supplemental oxygen ● Basic techniques ● Basic adjuncts ● Definitive airway ● Cuffed tube in the trachea ● Difficult airway adjuncts ● Unexpected difficult airway ● Predicted difficult airway EMCON 2014 Mumbai
- 8. Airway Decision Scheme EMCON 2014 Mumbai
- 9. Challenges • Head Position to align Intubation Axis • C-Collar • Decision to Intubate • Decision to use drug assisted intubation EMCON 2014 Mumbai
- 10. Challenges • Alternate airway solutions • Expertise to perform surgical airway • Maxillo Facial injuries • Airway Burns EMCON 2014 Mumbai
- 11. Video Laryngoscope •Less neck movement •Blood in the throat •Oro-facial injuries EMCON 2014 Mumbai
- 12. Air manipulation without obtunding reflexes • Laryngospasm • Bronchospasm • Tachycardia • Hypertension • Intracranial tension • Intra ocular tension • Vomiting Deleterious Airway Breathing Circulation Disability Extra EMCON 2014 Mumbai
- 13. Solutions • Lack confidence • Surgeons mania • Ketamine is safe • Suxamethonium related issues • Rocuronium • Reversal agent for Rocuronium Drug assisted intubation Awake intubation with adequate airway block Adequate training is essential EMCON 2014 Mumbai
- 14. Venugopalan.P.P.INTEM 2010;:Nov;10-14 Ahammadabad, IND. Ketamine in TBI ? Effect of IV Ketamine on ICP/CPP/MAP in 8 ventilated TBI patients with ICP monitors in place # ICP reduced # No alteration in CPP # No alteration in MAP Albanese J.Anesthesiology 1997;87;1328.
- 15. Venugopalan.P.P.INTEM 2010;:Nov;10-14 Ahammadabad, IND. Ketamine in TBI ? Ketamine produced a slight reduction in ICP without increasing cerebral blood flow velocity in patients undergoing isoflurane/nitrous oxide anesthesia for craniotomy Mayberg et al Anesth Analg 1995;81:84-89
- 16. Venugopalan.P.P.INTEM 2010;:Nov;10-14 Ahammadabad, IND. Ketamine in TBI ? • Several authors have recently questioned the historical dogma • Potentially advantageous in hypotensive head injury • No data in ED RSI population Himmelseher s. Anesth Analg 2005;101:524 Sehdev RS Emerg Med Austral 2006;18:37
- 17. Venugopalan.P.P.INTEM 2010;:Nov;10-14 Ahammadabad, IND. RSI: Paralytic Agents Rocuronium At a dose of 1.0 mg/kg • 95% of the patients ready in 60 seconds • Success rate is comparable to Succinylcholine • Average duration of action 45 minutes PerryJJ.Acad Emerg Med 2002;9:813. Kirkegaard-Nielson H. Anesthesiology 1999; 19:131.
- 18. Succinylcholine & Rocuronium • The Cochrane meta-analysis concluded “Succinylcholine created superior intubation conditions to Rocuronium when comparing both excellent and clinically acceptable intubating conditions.” Perry J, Lee J, Sillberg VAH, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. (database online). Cochrane Database Syst Rev 2008;(2):CD002788. Venugopalan.P.P.INTEM 2010;:Nov;10-14 Ahammadabad, IND.
- 19. Sugammadex (Bridion) Venugopalan.P.P.INTEM 2010;:Nov;10-14 Ahammadabad, IND. Rocuronium Antagonist New New
- 21. No Yes Venugopalan.P.P.INTEM 2010;:Nov;10-14 Ahammadabad, IND. RSI- Paralytic Agents Fundamental question Is the patient at risk for an important Succinylcholine related complication? Succinylcholine 1.5mg/kg Rocuronium 1mg/kg
- 22. Regional Block for intubation •Vocal cord and Vallecular spray •Superior laryngeal Nerve block •Trans Tracheal injection to block Recurrent laryngeal nerve EMCON 2014 Mumbai
- 23. Vocal Cord spray
- 24. SLN block
- 26. Airway can be tricky always EMCON 2014 Mumbai
- 27. www.drvenu.net www.emergencymedicinemims.com EMCON 2014 Mumbai