AIRWAY MANAGEMENT IN EMERGENCIES - PART 1 pot

[...]... professional skills training and assessment JAMA 19 99;282(9): 8 61 866 8 Hall RE, Plant JR, Bands CJ, et al Human patient simulation is effective for teaching paramedic students endotracheal intubation Acad Emerg Med 2005 ;12 (9):850–855 9 Schull MJ, Ferris LE, Tu JV, et al Problems for clinical judgement: 3 Thinking clearly in an emergency CMAJ 20 01; 164(8) :11 70 11 75 10 Leach J Why people ‘freeze’ in an emergency:... GCS is 15 view endotracheal intubation as the definitive intervention of airway management, other maneuvers, often perceived as basic, are all potentially life saving Recognition of the obstructed airway, airway opening maneuvers, the administration of high flow oxygen, and bag-mask ventilation (BMV) are all crucial airway management skills In most cases it would be inappropriate to proceed with intubation... appreciated that active airway interventions such as intubation are not without complications Intubation for the indications of obtaining and maintaining a patent airway and correction of gas exchange may be mandated urgently as part of the “ABCs” (airway, breathing, circulation) of resuscitation On the other hand, intubation for the sole indication of airway protection or predicted clinical deterioration... and gag reflex in healthy subjects Lancet 25, 19 95;345(8948):487–488 3 Altschuler SM Laryngeal and respiratory protective reflexes Am J Med 3, 20 01; 111 (Suppl 8A):90S–94S DEFINITIVE AIRWAY MANAGEMENT: WHEN IS IT TIME? 4 Mackay LE, Morgan AS, Bernstein BA Swallowing disorders in severe brain injury: risk factors affecting return to oral intake Arch Phys Med Rehabil 19 99;80(4):365–3 71 5 Advanced Trauma...This page intentionally left blank 2 CHAPTER 1 ᭤ TABLE 1 1 AIRWAY MANAGEMENT CORE COMPETENCIES Cognitive Psychomotor Affective • Indications for advanced airway management • Relevant airway anatomy and physiology • Predictors of the difficult airway • Approach to the difficult airway whether predicted or not • Indications and contraindications for rapid sequence intubation and awake intubation • Airway. .. progressive airway edema which may eventually threaten airway patency Critical narrowing at the laryngeal inlet is often heralded by inspiratory stridor Stridor should generally be regarded as a sign of impending complete airway obstruction Intubation is indicated in this patient to obtain and maintain a patent airway and for predicted clinical deterioration While making preparations for intubation,... work at enhancing the knowledge and skills needed for successful airway management in emergencies 3 REFERENCES 1 Kovacs G, Croskerry P Clinical decision making: an emergency medicine perspective Acad Emerg Med 19 99;6(9):947–952 2 Kovacs G, Bullock G, Ackroyd-Stolarz S, et al A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance Ann... Esophageal-Tracheal Combitube (ETC) are also very effective at providing gas exchange, placement of an ETT remains a gold standard for airway management in emergencies ᭤ INDICATIONS FOR ENDOTRACHEAL INTUBATION ᭤ Case 2.5 A 35-year-old female, well known in the intensive care unit, has been receiving maximal medical therapy for an acute exacerbation of asthma She remains “tight” and is moving very little... nonrebreathing face mask should be administered The patient will require intubation for a number of reasons: airway maintenance, airway protection, and predicted clinical course The condition of this patient is too tenuous for her to be sent to the diagnostic imaging department without having an airway secured by intubation ᭤ Case 2.3 A 35-year-old female, 8 months pregnant, was involved in a motor... consciousness, and now maintaining her own airway, did not acutely require intubation ᭤ Case 2.4 A 55-year-old male was in a house fire Although his burns seemed limited, 6 hours after the injury he started complaining of shortness of breath, and subsequently developed stridor on inspiration His BP is 16 0/90, HR 90, RR 30, SaO2 92% with NRFM, and his GCS is 15 The patient with an inhalational thermal injury can . Management 17 9 11 . Approach to Tracheal Intubation 18 7 12 . Response to an Encountered Difficult Airway 19 9 13 . Airway Pharmacology 211 14 . Central Nervous System Emergencies 237 15 . Cardiovascular Emergencies. Problems for clin- ical judgement: 3. Thinking clearly in an emer- gency. CMAJ. 20 01; 164(8) :11 70 11 75. 10 . Leach J. Why people ‘freeze’ in an emergency: temporal and cognitive constraints on survival responses airway edema. It must be appreciated that active airway interventions such as intubation are not without complications. Intubation for the indications of obtaining and maintaining a patent airway