Instructor Airway in Trauma Indications n Control IICP

Instructor 張志華 Airway in Trauma

Indications n Control IICP – Pa. CO 2 : 25 -30 mm. Hg n Respiratory failure – CPR, flail chest, severe shock n Obtain airway – Potential of airway compromise (e. g. gunshot) n Protect airway – Aspiration risk, thermal / caustic airway burn Instructor 張志華

Orotracheal Intubation n C-spine immobilization – In-line stabilization – Do not apply traction n Technique – Rapid sequence intubation (RSI) – Sedation-aided intubation (SAI) Instructor 張志華

Orotracheal Intubation Difficult Intubation : – Short muscular neck – Mentum-hyoid distance < 3 f. b. – Open mouth < 3 cm Instructor 張志華

Rapid Sequence Intubation n Prepare : Equipment Preoxygenation : 100% 3 -5 min Premedications (3 min) : – – n n Lidocaine 1. 5 mg/kg Pancuronium 0. 01 mg/kg Atropine 0. 02 mg/kg (if < 5 yr) Thiopental 3 -5 mg/kg Paralysis : Succinylcholine 1. 5 mg/kg Pass the tube Instructor 張志華

Succinylcholine n Succinylcholine – Dose 1. 5 mg/kg – Onset 30 -60 sec; duration 4 -6 min n Contrindications – Open globe injuries – Burns, crush injuries, or paralysis over 48 hr and under 6 wk old (cause hyperkalemia) – IICP without pretreatment (lidocaine, defasciculating agent, sedative) Instructor 張志華

Sellick Maneauver n Method : – Cricoid pressure n Indication : – Prevent regurgitation and aspiration n To apply : – Just after the administration of succinylcholine n To release : – After successful intubation and ET cuff inflated Instructor 張志華

Ketamine n Pharmacokinetic : – Dose 2 mg/kg; onset 60 sec; duration 15 min n Advantages : – – n Less respiratory depression Intact protective airway reflexes Does not lower BP Bronchodilator (best choice in status asthmaticus) Contraindication : IICP Instructor 張志華

Nasotracheal Intubation n Contraindications : – Apnea – Severe maxillofacial trauma – Basilar skull fracture – Coagulopathy (coumadin, cirrhosis, hemophilia) – IICP without pretreament (lidocaine, sedative) Instructor 張志華

Cricothyroidotomy n Contraindications : – Age < 12 yr u Consider needle cricothyroidotomy + jet ventilation (30 - 45 min) followed by tracheostomy – Laryngeal pathology (tumor, fracture, hematoma) u Consider needle tracheotomy above sternal notch + jet ventilation (30 - 45 min) followed by tracheostomy – Tracheal transection Instructor 張志華

Pediatric Intubation n Sniffing position – Without padding the occiput n Straight blade – Stiffer and shorter epiglottis n Uncuffed ET tubes – If < 10 yr; smallest diameter at cricoid ring n Tube size – 4 + age/4; child’s little finger Instructor 張志華