Pre-hospital and ER Management of Difficult Airway in Trauma Patient - PowerPoint PPT Presentation

Loading...

PPT – Pre-hospital and ER Management of Difficult Airway in Trauma Patient PowerPoint presentation | free to view - id: 44a8f7-MzU1N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Pre-hospital and ER Management of Difficult Airway in Trauma Patient

Description:

Pre-hospital and ER Management of Difficult Airway in Trauma Patient . . – PowerPoint PPT presentation

Number of Views:245
Avg rating:3.0/5.0
Slides: 120
Provided by: Adm9174
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Pre-hospital and ER Management of Difficult Airway in Trauma Patient


1
Pre-hospital and ER Management of Difficult
Airway in Trauma Patient
  • ??.????????? ???????????
  • ??.???????

2
Airway Decision Scheme
3
(No Transcript)
4
  • ????????????????suction, O2 , laryngoscope,
    LMA , surgical /needle cricothyroidotomy
    protect C-Spine Preoxygenate

  • No
  • ???????????????????????????
    Definitive airway / Surgical airway
  • Yes

    Difficult
  • ??????????????????????????????????? LEMON
  • Easy
  • ??????????????????????? cricoid pressure
    ???????????????
  • Unsuccessful
  • ??????????????????? ( LMA, LTA,GEB)
    awake intubation
  • ????????? Definitive airway/ Surgical airway

5
Encountered Difficult Airway algorithm
6
(No Transcript)
7
  • ????????????????????????????????????
    ???
  • ????? bag mask ventilation ( BMV)
  • ???????1 ??????????????????????????????
    ??????
  • ???????2 ??????????????????????????????
    ?????????


8
  • ???????1 ????????????????????????????
    ????????
  • ??????????????
    ??????????????????
  • ???????????????????????
    ??????
  • best look, ??????????? blade,??? alternative
    intubation techniques

  • ????????????
  • ???????????????? BMV
    ??????????

9

  • ????????????
  • ????????????????????????????
    ?
  • ??????????????????????? , alternative
    intubation techniques

  • ????????????
  • ??????????????????????????????????????????
    (failed intubation)
  • ???????????? BMV ????
    EGD

10
  • ???????2 ????????????????????????????
    ???????????
  • ????????????????????????
    ???
  • ???? Failed Oxygenation ( Sat lt90
    ?????? BMV )
  • ???????????????????
    cricothyrotomy
  • ???????????? EGD
    ????????????????????

  • ????????????
  • ????????? EGD ???????????????????
    ?
  • ???????? cricothyrotomy???????
    ??????


11
  • ??????????????????????????????
    ???????????
  • ??????????????????????????????????????????
    ????????????? ???????? definitive care
  • ?????????????????????????????????????????
    ????


12
???????
  • 1) Airway
  • - ?????????????????????????????????
  • - ????????????????????????????????????????
    ??????????
  • 2) Ventilation
  • - ?????????????????????????????????????????
    ?

13
???????
  • 3) Airway Management
  • - Chin-Lift Maneuver - Jaw-Thrust
    Maneuver
  • - Oropharyngeal Airway - Nasopharyngeal
    Airway
  • - Laryngeal mask Airway - Gum Elastic
    Bougie
  • - Definitive airway

14
???????
  • 4) Difficult intubation
  • - LEMON
  • - Airway Decision Scheme
  • - Technique for rapid sequence intubation (
    RSI)
  • - Surgical Airway

15
Airway
16
?????????????????????????????
17
(No Transcript)
18
?????????????????????????????
  • 1 ) Look
  • ? ????????????????????????
  • ? ??????????????????????????????????????????????
    ????????
  • ? ?????????????????????????????????? /
    ???????????
  • ? ?????????????

19
?????????????????????????????
  • 2) Listen
  • ? ??????????????????????????? ????????,
    ??????????
  • ? ????????
  • 3) Feel
  • ? ????????????????????????????????????????????

20
?????????????????????????????
  • ????????????????????????????????
    ?????????????
  • ??????????????????

21
?????????????????????????????????????????
22
Maxillofacial Trauma
  • Trauma to the midface
  • ? ?????????????????????????????? nasopharynx
    ???? oropharynx
  • ??????????? , ????????????????????????????

23
Maxillofacial Trauma
  • Fracture of mandible
  • ? ??????????????? bony fracture
    ????????????????????
  • ????????????????????????????
  • ? ???????????????????????????????????????
    ?????????????????????? ??????????????????????????
    ??????? ????????????

24
Neck Trauma
  • Penetrating injury
  • ? ??????????????????????? ??????????????????????
    ???????

25
Neck Trauma
  • Blunt injury
  • ? ?????????????????????????????? larynx ????
    trachea
  • ??????????????????????
  • ???????????????? tracheobronchial tree

26
Neck Trauma
  • ???????????????????????
  • ???????????????
  • fails

  • surgical airway

27
Laryngeal Trauma
  • Clinical signs ??????????????????????????????????
    ???? larynx
  • 1) Hoarseness
  • 2) Subcutaneous emphysema
  • 3) Palpable fracture

28
Laryngeal Trauma
  • ??????????????????????????? airway obstruction
  • ?????????????????????????????????
    ????????????????????????? , jugular vein, carotid
    artery
  • ???????????????????????? ? CT

29
Ventilation
30
????????????????????????????????
31
????????????????????????????????
  • Look
  • ? ?????????????????????????
  • ? ?????????????????????????????
  • ? ????????????????????
  • ? ?????????????????????? ?????????????
    ?????????????????????????? ??????????

32
????????????????????????????????
  • Look
  • ? ???????????????????????????????
  • ? ????????????
  • ? ??????????????????????????????????????????????
    ??????????????
  • ????????????????????????????

33
????????????????????????????????
  • 2) Listen
  • ? ??????????????????????????????????????????????
    ????????

34
????????????????????????????????
  • 3) ?????? pulse oximeter
  • ? ??????? oxygen saturation ??? peripheral
    perfusion
  • ? ?????????? ventilation

35
????????????????????????????????
  • 4) Feel
  • ? ?????? trachea shift
  • ? ??????????
  • ????????????????
  • subcutaneous emphysema

36
?????????????????? (Ventilation)???????????????
?????????
37
Rib Fracture

  • ????????????
  • ????????????????
  • ?????????????????????
    ?

38
Intracranial Injury
  • ??????????????????????
    ???
  • ???????????????????
    ?????
  • ???????????????????
    ???

39
Cervical Spinal Cord Injury
  • ?????????????????????????????????????????
  • ??????????????????????

40
Complete Cervical Cord Transection
  • ?????????????????????????? phrenic nerves( C3
    ??? C4)
  • ?????????????????????????????
  • ?????????????

41
Airway Maintenance techniques
42
Chin-lift Maneuver
43
(No Transcript)
44
Jaw-thrust Maneuver
45
(No Transcript)
46
Orophayngeal Airway
47
(No Transcript)
48
Orophayngeal Airway
  • ?????????????????????????? ???????? gag reflex
    ???? cough reflex
  • ?????????????????
  • tip ? corner of mouth
  • flange ? angle of mandible

49
(No Transcript)
50
Pitfall
51
Nasopharyngeal Airway
52
(No Transcript)
53
Nasopharyngeal Airway
  • ?????????? conscious semiconscious
  • ????????????????????? ? ??????????????????????
  • ??????? ? ???????? - ??????

54
Pitfall
55
Extraglottic device (EGD)
56
Extraglottic device (EGD)
  • ??????????????? supraglottic devices
  • ????????????????????????????????????????
  • vocal cord
  • ?????????????????????????????????????????????????
    ????????????????????????? vocal cord

57
Extraglottic device (EGD)
  • ?????? Laryngeal mask airway, Combitube ,
    Laryngeal Tube Airway
  • ?????????????? failed intubation
  • ? ???????????????????????????????
  • ? ?????????????????????? EGD
  • ?????????????????????????????? definitive
    airway ????

58
Laryngeal Mask Airway
59
(No Transcript)
60
(No Transcript)
61
The Esophageal-Tracheal Combitube ( ETC)
62
(No Transcript)
63
Laryngeal Tube Airway
64
(No Transcript)
65
Alternative Intubation Techniques
66
Alternative Intubation Techniques
  • ??????????????????????????????????
    ??????????????????????????????????????????????????
    ?????????????????????????????
  • ???????????????????????????????????????????????
    best look ? ????????????????????????????????????
    ????????????? ????????? alternative intubation
    techniques ?????

67
LMA Fastrach
68
(No Transcript)
69
Lightwand ( e.g.Trachlight)
70
(No Transcript)
71
Videolaryngoscopy( e.g.Glidescope)
72
(No Transcript)
73
Definitive Airway
74
Definitive Airway
  • Orotracheal tube
  • Nasotracheal tube
  • Surgical airway
  • - cricothroidotomy
  • - tracheostomy

75
Manual in line stabilization
76
Surgical Cricothyroidotomy
77
(No Transcript)
78
(No Transcript)
79
(No Transcript)
80
????????????????? definitive airway
81
????????????????? definitive airway
  • ??????? apnea
  • ????????? maintain airway patent
  • ???????????????? aspiration
  • ?????????????????????????????
  • - inhalation injury
  • - facial fracture
  • - retropharyngeal hematoma

82
?????????????????
  • 5.Closed head injury ??? (Glasgow Coma score lt
    8)
  • 6. ??????????? oxygenation ?????????????? face
    mask
  • ?????????????????????? cervical spine

83
LEMON Assessment for Difficult Intubation
84
LEMON assesment for difficult intubation
  • LEMON
  • L ? look externally
  • E ? evaluate the 3-3-2 rule
  • M ? mallampati
  • O ? obstruction
  • N ? neck mobility

85
L Look externally
  • ??????????????????????????????????????????????????
    ??????

86
E Evaluate the 3-3-2 rule
  • ???????????????incisor ? ?????????? 3 finger
    breaths (???????????????? )
  • ??????????????? hyoid bone ??? chin? ?????????? 3
    finger breaths
  • ??????????????? thyroid notch ??? floor of mouth?
    ?????????? 2 finger breaths

87
(No Transcript)
88
Mallampati Airway Classification
  • Class 1? soft palate, uvula, fauces, pillars
  • Class 2? soft palate, uvula, fauces visible
  • Class 3? soft palate ,base of uvula visible
  • Class 4?hard palate only visible

89
(No Transcript)
90
Obstruction
  • ??????????????????????????????????????????????????
    ???? laryngoscopy ??? ventilation ????????
  • ???????? epiglottitis, trauma

91
Neck Mobility
  • ??????????????????????????????????????????????????
    ????
  • ???????????????????????????????

92
Rapid Sequence Induction
93
(No Transcript)
94
????????????
  1. ????????????????????? surgical airway ????????
  2. ?????? suction ambu-bag
  3. ??? 100 ??????????????????
  4. ?? cricoid cartilage
  5. ????? induction drug ?etomidate 0.3 mg ?????????
    sedate

95
Sellick maneuver
96
????????????
  1. ??? succinylcholine 1-2 mg/kg
  2. ??????????????????????????????????????????????????
  3. Blow cuff ?????????????? CO2
  4. ???????????????? cricoid pressure
  5. ????????????????

97
Components Of BEST LOOK Laryngoscopy
98
Sniffing Position
99
Sniffing Position
  • ?????????????????????? cervical spine ???
    thoracic spine ???????????? atlantoocipital
  • ??????????????????????????????????? 7-10
    ???????????????????
  • ????????????? ?????? oral cavity, pharynx, larynx
    ????????????????????????? glottis ???

100
(No Transcript)
101
BURP Maneuver
102
BURP Maneuver
  • ??? technique ???????laryngeal manipulation
    ???????????????? vocal cord ??????
  • B ? Backward
  • U ? Upward
  • RP? Rightward Pressure

103
(No Transcript)
104
Laryngoscope Blade
105
Laryngoscope Blade
  • Blade ??????? ( Miller)
  • ??????? blade ?????????? epiglottis
  • ?????????????????

106
Laryngoscope Blade
  • Blade ???????? ( Macintosh)
  • ??????? blade ?????? vallecular
    ???????????
  • epiglottis
  • ????????????????

107
Gum Elastic Bougie
108
Gum Elastic Bougie
109
Airway Management
110
Airway Decision Scheme
111
(No Transcript)
112
  • ????????????????suction, O2 , laryngoscope,
    LMA , surgical /needle cricothyroidotomy
    protect C-Spine Preoxygenate

  • No
  • ???????????????????????????
    Definitive airway / Surgical airway
  • Yes

    Difficult
  • ??????????????????????????????????? LEMON
  • Easy
  • ??????????????????????? cricoid pressure
    ???????????????
  • Unsuccessful
  • ??????????????????? ( LMA, LTA,GEB)
    awake intubation
  • ????????? Definitive airway/ Surgical airway

113
Encountered Difficult Airway algorithm
114
(No Transcript)
115
  • ????????????????????????????????????
    ???
  • ????? bag mask ventilation ( BMV)
  • ???????1 ??????????????????????????????
    ??????
  • ???????2 ??????????????????????????????
    ?????????


116
  • ???????1 ????????????????????????????
    ????????
  • ??????????????
    ??????????????????
  • ???????????????????????
    ??????
  • best look, ??????????? blade,??? alternative
    intubation techniques

  • ????????????
  • ???????????????? BMV
    ??????????

117

  • ????????????
  • ????????????????????????????
    ?
  • ??????????????????????? , alternative
    intubation techniques

  • ????????????
  • ??????????????????????????????????????????
    (failed intubation)
  • ???????????? BMV ????
    EGD

118
  • ???????2 ????????????????????????????
    ???????????
  • ????????????????????????
    ???
  • ???? Failed Oxygenation ( Sat lt90
    ?????? BMV )
  • ???????????????????
    cricothyrotomy
  • ???????????? EGD
    ????????????????????

  • ????????????
  • ????????? EGD ???????????????????
    ?
  • ???????? cricothyrotomy???????
    ??????


119
  • ??????????????????????????????
    ???????????
  • ??????????????????????????????????????????
    ????????????? ???????? definitive care
  • ?????????????????????????????????????????
    ????

About PowerShow.com